Care of the Older Patient

7/23/2019 Care of the Older Patient

1/33

Assessment of the Elderly Patient

Noel H. Ponce MD


2/33

Life Expectancy and Life Span

Life span

maximum ae that can !e attained !y a

mem!er of particular species "##$%##& y' Life expectancy

a(erae num!er of yrs of an indi(idual

!ased on li(in conditions) medicalad(ances) natural disasters and other

factors


3/33

Life Expectancy for *ilipinos

"years'

Male *emale

#+,- ,-.- &.,

#+-$ &/.+ /$

#++# /0.+ /1./

0$$, /1 10

#. 2orld Population 3rends) 3he Americana

Annual

0. 4eader5s diest Almanac and 6ear!oo7) #+-#

p.,1

. SEAM89 Health Statistics) #++0

,. Population 4eference :ureau) 0$$0

10

20

30

40

50

60

70

80

1948 1980 1991 2003

male

female


4/33

8nfant Mortality 4ate

#+&0% #$-.+

#+/$% 1.#

#+-1% 0

#++&% #-.+

0$$% 0/

#. 2orld Population 3rends) 3he

Americana Annual) #+&- p./0&

0. SEAM89 Health Statistics

. Population 4eference :ureau) 0$$

0

20

40

60

80

100

120

1952 1987 2003

/1000 live

birth


5/33

Population o(er ae /&

#+1&% 0.+;

#+-&% .,;

#++&% .&;

0$$% ,;

#. SEAM89 Health Statistics

0. Population 4eference :ureau) 0$$

0

0.5

1

1.5

2

2.5

3

3.5

4

1975 1985 1995 2003

%


6/33


7/33

*unctional 9lassification

6oun old 8ndependent

/$ to /+ yrs

>ld old 4e?uire assistance in household mt

1$ to 1+ yrs

>ldest old 4e?uire assistance in personal tas7s

-$ yrs and a!o(e


8/33

*unctional 4eser(e

>ran system5s capacity to maintain

homeostasis in the face of challene

Homeostenosis

8nfluenced !y diet) en(ironment)

personal ha!it and enetic factors


9/33

*unctional 4eser(e


10/33

Average decrease in selected physiological

variables between ages of 30 and 80

Variable % reduction

4estin 9> $ @ital capacity &$

4enal !lood flo &$

Maximum !reathin /$

capacity

Maximum $0 upta7e 1$


11/33

*eatures of the Elderly Patient

Spectrum of symptom is different

Presentation of disease fre?uently non%

specific 8mplications of function are more important

8mpro(ement is less dramatic and slo toappear

Differential dianosis often different Symptoms are difficult to interpret


12/33


13/33

@ision

, maBor eye diseases

9ataract

Macular deeneration DM retinopathy

P


14/33

Hearin

Hearin loss

Prohi!its easy and effecti(e communication

Social isolation

psychosocial pro!lem

Audioscope or hispered (oice test

Amplification de(icesimpro(ed functional

status


15/33

Nutrition

Protein enery undernutrition

9linical "astin) lo :M8'

:iochemical "al!umin) cholesterol'

All px should !e eihted at e(ery

office (isit

8n(oluntary t loss C#$ l!s o(er / mos orC,; o(er a yr


16/33

MEALS%>N%2HEELS APP4>A9H 3> D8AS8N* MALN38438>N Medications

Emotional pro!lems "depression'

Anorexia ner(osa

Late%life paranoia

Salloin pro!lems

>ral pro!lems

No money 2anderin and other dementia%related !eha(iors

Hyperthyroidism) hyperparathyroidism

Entry pro!lems "mala!sorption'

Eatin pro!lems "physical and coniti(e'

Lo salt) lo cholesterol diet Shoppin "food a(aila!ility'


17/33

9ontinence

rinary incontinence% not part of normal

ain

Em!arrassed to raise issue

Screenin

8n the past year) ha(e you e(er lost

urineFG Ha(e you lost urine on at least / separate

daysFG


18/33

Ad(erse effects

Social isolation

Stress

S7in !rea7don 4ecurrent 38

*alls

Hih economic cost


19/33


20/33

Medication se

Polypharmacy

3oo many drus

Drus for too lon a time

Drus in exceedinly hih doses

Ad(erse Dru 4eactions

Dru%dru interaction

Dru%disease interaction


21/33

9onition

N$Mild 9oniti(e 8mpairmentAD

Assessment

Mini Mental Status Examination "MMSE' 9loc7 drain test

3ime and 9hane test


22/33

Affect

Depression

disorder characteried !y feelins of

sadness and despair and ranin from mildto life threatenin

EtioloyI :iopsychosocial

ScreeninI


23/33

9onse?uences of failure in reconition

Social isolation

4educed J>L

:urden to family) society) economy 8ncreased MKM

Suicide ris7


24/33

*unction

Essential component

Assessed in le(els

:asic Acti(ities of Daily Li(in

8nstrumental Acti(ities of Daily Li(in

Ad(ance Acti(ities of Daily Li(in


25/33

:asic Acti(ities of Daily Li(in

*eedin

Dressin

Am!ulation

3oiletin :athin

3ransfer

9ontinence


26/33

8nstrumental Acti(ities of Daily Li(in

2ritin

4eadin

9oo7in

9leanin

Shoppin

Doin laundry

9lim!in stairs

sin telephone

Manain medications and money

A!ility to tra(el


27/33

Ad(ance Acti(ities of Daily Li(in

Societal) community and family roles

4ecreational or occupational tas7s


28/33

En(ironment

0 dimensions

Safety of home en(ironment

Access to needed personal and medicalser(ice

Home safety e(aluation


29/33

Spirituality

*re?uent attendance of reliious ser(ice is

associated ith loer health care utiliation

and mortality rate Hospital% pastoral care (alua!le


30/33

Ad(ance Directi(es

Leal statement that allo persons to

articulate (alues and esta!lish tx preference

in the future hen capacity has lapsed 8nstruction directi(es

Proxy directi(es

@alues history


31/33

Mor!idity rateK #$$)$$$ population#

>lder Persons lder PersonsI An Assessment of their Health Status) Needs) Access to andA(aila!ility of 9are) *acilities and Ser(ices. April 0$$$


32/33

Mortality 4ateK#$$)$$$ Population#

>lder persons PDK allied conditions 0$.$, #/.&

>ther dses of resp. system #0.$- +.-

DM #00./+ +.-

Nephritis) Nephroticsyndrome and nephrosis -/.#$ +./

Accidents //.,1 0#. :altaar B.) @alencia E. Profile of >lder PersonsI An Assessment of their Health Status) Needs)

Access to and A(aila!ility of 9are) *acilities and Ser(ices. April 0$$$


33/33

3han7 6ou

Date post:	14-Feb-2018
Category:	Documents
Upload:	lovelots1234
View:	214 times
Download:	0 times

Care of the Older Patient

Documents