Assessing an Elderly Person
Brief Introduction and Background information
The interviewee was introduced through a friend because this older man is his grandfather. Their family consists of three children, two parents, and two grandparents.
Philosophy on living a long life
He believes that being happy and surrounding yourself with few but close people is a key to a longer life.
Thoughts about when a person is considered “too old”
He states that age is merely a number, and that is why it depends on a person because an 80-year-old person can be in better condition than a 50-year-old with an unhealthy lifestyle.
Opinion on the status and treatment of older adults
He thinks that the current state of treatment of older adults is satisfactory.
Beliefs about health and illness
He believes that health and wellbeing are not solely determined by nutrition and training but also psychological happiness.
Health promotion activities he or she participates in
He was an active participant in various marathons for older people, but currently, he only performs light exercises.
Something special that helped the person live so long
He is convinced that his spouse played a major role in the overall longevity because they understand each other well.
The life span of other family members
His spouse is a 69-year-old woman, and his son and daughter-in-law are 44 and 45, respectively.
Special dietary traditions in a patient’s culture attributed with aiding long life
He is an active meat eater, but he actively avoids refined sugar and processed food.
Any remedies/medications that have been handed down in family/group
He did not state any medication or remedies that have been handed down in the given family.
Patient’s description of current and past health status
Currently, he is in normal shape and mostly healthy for his age. However, he stated that he used to smoke cigarettes for 13 years since he was 21 years old.
The values that guided life so far
He holds strong Christian values; thus, he states that he highly values compassion and love.
Additional questions
How many hours do you walk a day?
He states that he does not walk as much as he used to do before due to his knee problems, but he tries to go out for an hour.
What do you eat for meals?
He enjoys eating red meat with some fresh vegetables but avoids consuming processed food. He seems to be on some form of the ketogenic diet because his son and daughter-in-law are proponents of the given form of nutrition.
What kind of discomfort do you experience while walking?
He describes that his knees feel tight and resistant to stretching.
Summary
In summary, it was clear that the patient does not lead a fully sedentary lifestyle. He reported nothing on discomfort levels, but it is important to note that his diet is deficient in some essential micronutrients, which are needed for his muscle and skeletal strength. The patient was asked to undergo both Tinetti Balance and Gait Evaluation. Tinetti testing showed that the risk of fall was low due to the score of 25, whereas the Gait testing revealed a mild form of knee pathology. After, the patient underwent the Katz Index of Activities of Daily Living analysis, where his score was 5 out of 6, which meant that he was fairly independent in daily tasks. Home Safety Assessments showed that his living conditions and the overall surrounding environment were safe partially due to the presence of other family members who create the given circumstance. Lastly, the Barthel Index resulted in a score of 77, which meant that he was dependent on a highly minimal level.
Planning Care for an Elderly Person
The biggest age-related changes of the patient are the weakness of the knees and poor posture. Prevention of falls is one of the important problems in today’s aging society, and this is a real opportunity to prevent serious consequences in the elderly. The complexity of determining intervention strategies to reduce the risk of falls in people of older age groups is due to the multifactorial nature of the causes of falls. This determines the need to develop a comprehensive program for risk stratification and fall prevention. The multifactorial nature of the causes of falls is explained by the interaction of biological, behavioral, environmental, and socio-economic factors (Pacella et al., 2015). Etiological factors of falls include internal and external predisposing factors. The likelihood of falls in older adults living both at home and in a care facility exponentially increases as the number of exposure risk factors increases.
The incidence of falls increases with the burden of chronic diseases. Thyroid dysfunction with hyperthyroidism, diabetes mellitus, and arthritis, leading to impaired peripheral sensitivity, also increases the risk of falls. The prevalence of falls in the population due to cardiovascular disorders is unknown, but dizziness is often observed in victims of falls. Cases of depression and urinary incontinence are also common in this group; impaired motor function and gait, which are directly associated with sarcopenia. In conditions of a significant decrease in physical strength, endurance, muscle performance, and impaired motor functions, a person is unable to resist falling. Muscle weakness is a considerable risk factor for falls, as well as impaired gait, balance, or the use of walking aids (Jaul & Barron, 2017). Any functional disorders of the lower extremities and a decrease in muscle strength, orthopedic pathology, or sensitivity disorders result in an increased risk of falls. Difficulty getting up from a sitting position is also associated with an increased risk of falls; sedentary lifestyle: people prone to falls are usually less active, and this can contribute to the further development of muscle atrophy as a result of their insufficient training.
A decrease of 14 days of daily physical activity due to illness is associated with an increased risk of falls. People with reduced activity fall more often than those showing moderate or high activity in safe conditions; fear of falls: almost 70% of people shortly before the survey suffered a fall, and up to 40% of those who did not have such cases reported fear of falls. A decrease in physical and functional activity is associated with anxiety and fear of falling. Up to 50% of people are experiencing fear of falling. Because of this, limit or completely stop social and physical activity (Yang et al., 2018). Fear of falling and the presence of falling cases were prognostic signs in relation to each other when observed for one year (Hill, 2015). Eating disorders are manifested in low body mass index, which indicates malnutrition, is associated with an increased risk of falls.
It is critical to note that there are some preliminary changes to the patient’s data analysis. These issues include hearing loss, visual acuity, muscular hypotrophy, and urologic changes. Another factor is vitamin D3 deficiency, which is especially common in older people living in a nursing home and can cause gait disorders, muscle weakness, and osteoporosis. Cognitive dysfunctions are also found: they are associated with an increased risk of falls, even with their relatively low severity. Visual impairment is a decrease in visual acuity, contrast sensitivity, size of visual fields, as well as cataracts, glaucoma, and retinal spot degeneration – all these factors affect the risk of falls, as well as wearing glasses with bifocal or multifocal lenses (Jaul & Barron, 2017). Multifocal lenses violate the deep perception of space and contrast visual sensitivity, which makes it difficult to detect external obstacles in a timely manner.
It is often difficult for an elderly and senile patient to service himself. The assistance should be given to him when changing bedding and underwear, and if necessary, to care for hair, nails, etc. It is necessary to monitor the patient’s oral cavity. After each meal, the nurse should give the patient boiled water so that he can thoroughly rinse his mouth. A seriously ill nurse must wipe her mouth with a swab moistened with a solution of hydrogen peroxide or a solution of sodium bicarbonate. When caring for a patient who has been in bed for a long time, it is necessary to carry out thorough skincare and prevent pressure sores. The nurse should help the patient to change the position in bed, periodically, if his condition allows, to sit on the bed for stability, propping up pillows on all sides, lightly massage the back, feet, and hands.
It is essential to understand that the patient possesses a certain amount of alterations, and these include hypertension, osteoarthritis, and osteoporosis. The elderly are not characterized by a sudden onset of the crisis, often it develops gradually over several hours, and its appearance is preceded by an increase in headaches, agitation, or a depressed mood. The issues are characterized by intense problems of a pressing, bursting, pulsating nature, often short-term visual disturbances – flashing flies in front of the eyes, fog, veil, as well as dizziness, nausea, and vomiting (Jaul & Barron, 2017). Severe speech, weakness of the limbs, and sometimes cramps of certain muscle groups appear. The pain in the left half of the chest, which is pressing and compressing in nature, palpitations, and shortness of breath are complementary to the clinical picture. Severe complications of a hypertensive crisis include cerebrovascular accident, retinal hemorrhage with partial or complete loss of vision, myocardial infarction, and pulmonary edema.
The list of mandatory studies includes a clinical blood test with platelet counts, determination of the concentration of cholesterol, sugar, electrolytes, creatinine in the blood, general urine analysis, electrocardiography. According to indications, ultrasound of the kidneys, intravenous urography, renography with captopril, renal angiography, echocardiography, 24-hour blood pressure monitoring are used (Jaul & Barron, 2017). Along with an increase in blood pressure, the most important diagnostic signs of hypertension itself are a tense, hard pulse, displacement of the borders of the heart to the left due to the left ventricle, electro-and echocardiographic signs of left ventricular hypertrophy, changes in the fundus in the absence of symptoms of damage to the aorta and its large branches. Subsequent involvement in the pathological process of the cardiovascular, nervous, urinary systems significantly modifies the clinical and laboratory manifestations of the disease. In addition, there is a strong sense of personal cultural awareness and cultural competency because the patient is African American, and he has seen discrimination during his early years of service.
In conclusion, the duration and intensity of crises are different. The patient’s uncomplicated course is characterized by short and completely passing symptoms, complicated by long-existing and often intensifying clinical manifestations. Physical, laboratory, and instrumental studies can exclude secondary hypertension, identify possible lesions of the aorta and its large branches, heart, brain, kidneys, eyes, and also determine the risk groups for the development of cardiovascular complications. The nurse should know and use in practice the methods of objective research, including measuring and evaluating blood pressure, palpation of the pulse on the radial, carotid, and femoral arteries, determining the boundaries and characterization of heart sounds. The procedure also involves listening to noise above the carotid arteries when they narrow and in the epigastric region with renal stenosis artery, measurement of height, and body weight. An ophthalmologist’s consultation has been shown to examine the fundus and to identify retinal retinopathy inherent in hypertension.
References
Hill, D. (2015). Age-related macular degeneration. InnovAiT, 8(7), 425-430.
Jaul, E., & Barron, J. (2017). Age-related diseases and clinical and public health implications for the 85 years old and over population. Frontiers in Public Health, 5(1), 334-335.
Pacella, E., Pacella, F., De Paolis, G., Parisella, F. R., Turchetti, P., Anello, G., & Cavallotti, C. (2015). Glycosaminoglycans in the human cornea: Age-related changes. Ophthalmology and Eye Diseases, 55(4), 1311-1345.
Yang, J. X., Pan, Y. Y., Wang, X. X., Qiu, Y. G., & Mao, W. (2018). Endothelial progenitor cells in age-related vascular remodeling. Cell Transplantation, 27(5), 786-795.