Transcript An Overview of Geriatric Health Care

An Overview of
Geriatric Health
Care
Dr. M.L. Donnelly
Division of Community Geriatrics
Vancouver-Fraser Medical Program
Department of Family Practice
University of British Columbia
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Today’s Schedule
• 1:00 – 2:00
– An Overview of Geriatric Health Care
• Dr. M.L. Donnelly (VFMP)
• 2:15 – 3:15
– local site: Geriatric Health Care resources
• VFMP: Dr. M.L. Donnelly
• IMP: Dr. David Evans, Clinical Instructor, UBC Dept. of
Family Practice
– Division of Geriatric Psychiatry – VIHA
» Medical Consultant to Seniors Mental Health and
Addictions Programs
• NMP: Dr. Ian Schokking
– Clinical Associate Professor – UBC Dept. Family Practice
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Asking questions in
today’s lecture
“4 words or
less”
otherwise
use the mike
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An Overview of
Geriatric Health Care
1. Demography
2. Normal aging
3. Disability and frailty
4. Values (theirs & ours)
5. Epidemiology
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An Overview of Geriatric
Health Care (cont’d)
6. Comprehensive geriatric assessment
7. Caregiver issues
8. Health promotion & prevention for
seniors
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Health, illness and disease may overlap, but they are uniquely different
facets of experience.
Labonte, 1993
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Statistic Canada’s 1986 Health
and Activity Limitation Survey
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83% of those 75 to 84 and 89% of those
85+ reported mobility and agility related
disabilities
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47% of those 75 to 84 and 65% of those
85+ reported hearing disabilities
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The CSHA Clinical Frailty Scale
1. Very fit – robust, active, energetic, well
motivated and fit; these people commonly
exercise regularly and are in the most fit
group for their age.
2. Well – without active disease, but less fit
than people in category 1
3. Well, with treated comorbid disease –
disease symptoms controlled compared
with those in category 4.
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The CSHA Clinical Frailty Scale
4. Apparently vulnerable – although not frankly
dependent, these people commonly complain of
being ‘slowed up’ or have disease symptoms
5. Mildly frail – with limited dependence on others
for instrumental activities of daily living.
6. Moderately frail – help is needed with both
instrumental and noninstrumental activities of
daily living
7. Severely frail – completely dependent on
others for the activities of daily living or
terminally ill
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Three Greatest Fears of Seniors
1. Poor health
2. Loss of independence
3. Inadequate income
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Determinants of Independence
Marshall, 1995
• Health
• Wealth
• Social integration
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Predictors of Institutionalization
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Availability of long-term care beds
• Absence of caregiver
• Functional incapacity
• Advancing age
• Presence of dementia
• Recent hospital admission
• Physical health deterioration
Note: lack of informal support is main
predictor
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The average age of
admission into a longterm care facility rose
from 75 in 1977 to 85
in 1997
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Geriatric Giants
1.
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Delirium
Dementia
Depression
Incontinence
Falling
Medications
Illness interactions
Atypical presentations in the elderly
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Incidence of Delirium in the
Acute Care Hospital >65
1988
1992
1995
Francis
25.4% med
Francis
22% med
Chonchubhair 10% elderly gen/sx
20% elderly ortho/sx
1991
Levkoff
up to 51% med/sx
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Canadian Study of Health
and Aging
Prevalence of Dementia
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Common Causes of Dementia
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Alzheimer’s disease
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Vascular dementia
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Frontal temporal dementia
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Dementia with Lewy Bodies
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Parkinson’s disease with dementia
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Prevalence of Depression
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Typical Altered Presentations of
Specific Illness in the Elderly
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Depression without sadness
Infectious disease without leukocytosis,
fever, or tachycardia
Silent surgical abdomen
Silent malignancy (“mass without
symptoms”)
Nondyspneic pulmonary edema
Apathetic thyrotoxicosis
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Comprehensive
Geriatric Assessment
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Comprehensive Geriatric
Assessment
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HX
Collateral
Fe
Pex
Msex
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Comprehensive Geriatric
Assessment (cont’d)
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Functional assessment
Informal supports
Formal supports
DRUG review
Nutritional review
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Activities of Daily Living
Instrumental ADL Scale
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Ability to use telephone
Mode of transportation
Responsibility of own medications
Ability to handle finances
Shopping
Food preparation
Housekeeping
Laundry
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Activities of Daily Living
Physical Self-Maintenance Scale
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Toileting
Feeding
Dressing
Physical ambulation
Bathing
Hobbies, leisure activities
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Comprehensive Geriatric
Assessment (cont’d)
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Investigations
HOME assessment
Risk assessment
Health prevention/
promotion issues
Advance directives
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Information obtained
from a home visit
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Suitability and safety of home for patient’s
functional level
Attitudes and presence of other persons at
home
Proximity and helpfulness of neighbors
and relatives
Emergency assistance arrangements
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Information obtained from a
home visit (cont’d)
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Nutritional and alcohol habits
Actual and required daily living skills
Hygiene habits
Safety and convenience
modifications needed
Problems in getting to local
stores and service
picture
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RISK
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Comprehensive Geriatric
Assessment (cont’d)
1.
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4.
Problems
Priorities
Goals
Care Plan
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Quality of Life
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Informal Caregiving
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80% of care provided for seniors is
informal care by family and friends
Government policies shifting care to the
community increase caregiver
responsibilities
The majority of informal caregivers are
women (most are either the spouse or
daughters)
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Informal caregiving (cont’d)
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Women find caregiving
more stressful than men
Most caregivers are over
60 themselves and suffer
from their own health care
problems
Care for the caregiver” “talk
or action”
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Informal Caregiving (cont’d)
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In a US study 52% of caregivers were
under significant strain (Marchi-Jones
1996)
Caregiver groups and education
Respite care
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Prevention and Health Promotion
for Seniors
1. Health Enhancement
• exercise
• diet
• coping skills (eg. stress reduction techniques, assertiveness
skills)
• Socialization
2. Risk Avoidance
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oral health
driving competency assessments
flu shots, pneumococcal vaccines
powers of attorney, advanced directives, levels of intervention
foot care
falls risk assessment
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Prevention and Health Promotion
for Seniors (cont’d)
3. Risk Reduction
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smoking
alcohol
medication knowledge, management
mobility aids
home safety
sun screens
optimize sensory input (sigh, hearing)
incontinence
osteoporosis management
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Prevention and Health Promotion
for Seniors (cont’d)
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Early Identification
• pap smears
• mammograms
• rectal examinations
• blood pressure
• thyroid status
5.
Complication reduction
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Friend or Enemy
I can look
At my body
As an old friend
Who needs my help
Or an enemy who frustrates me
In every way
With its frailty
And inability to cope.
Old friend,
I shall try
To be of comfort to you
To the end.
May Sarton, Coming into Eighty
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Geriatrics Mentoring Group
Interested?
Contact Martha Donnelly
([email protected]) or Jacquie
Bailey ([email protected])
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