Care of the Older Patient
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Transcript of Care of the Older Patient
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Assessment of the Elderly Patient
Noel H. Ponce MD
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Life Expectancy and Life Span
Life span
maximum ae that can !e attained !y a
mem!er of particular species "##$%##& y' Life expectancy
a(erae num!er of yrs of an indi(idual
!ased on li(in conditions) medicalad(ances) natural disasters and other
factors
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Life Expectancy for *ilipinos
"years'
Male *emale
#+,- ,-.- &.,
#+-$ &/.+ /$
#++# /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
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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
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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
%
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*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
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*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
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*unctional 4eser(e
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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 $0 upta7e 1$
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*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
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@ision
, maBor eye diseases
9ataract
Macular deeneration DM retinopathy
P
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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
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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
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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'
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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
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Ad(erse effects
Social isolation
Stress
S7in !rea7don 4ecurrent 38
*alls
Hih economic cost
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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
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9onition
N$Mild 9oniti(e 8mpairmentAD
Assessment
Mini Mental Status Examination "MMSE' 9loc7 drain test
3ime and 9hane test
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Affect
Depression
disorder characteried !y feelins of
sadness and despair and ranin from mildto life threatenin
EtioloyI :iopsychosocial
ScreeninI
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9onse?uences of failure in reconition
Social isolation
4educed J>L
:urden to family) society) economy 8ncreased MKM
Suicide ris7
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*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
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:asic Acti(ities of Daily Li(in
*eedin
Dressin
Am!ulation
3oiletin :athin
3ransfer
9ontinence
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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
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Ad(ance Acti(ities of Daily Li(in
Societal) community and family roles
4ecreational or occupational tas7s
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En(ironment
0 dimensions
Safety of home en(ironment
Access to needed personal and medicalser(ice
Home safety e(aluation
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Spirituality
*re?uent attendance of reliious ser(ice is
associated ith loer health care utiliation
and mortality rate Hospital% pastoral care (alua!le
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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
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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$$$
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Mortality 4ateK#$$)$$$ Population#
>lder persons PDK allied conditions 0$.$, #/.&
>ther dses of resp. system #0.$- +.-
DM #00./+ +.-
Nephritis) Nephroticsyndrome and nephrosis -/.#$ +./
Accidents //.,1 0#. :altaar B.) @alencia E. Profile of >lder PersonsI An Assessment of their Health Status) Needs)
Access to and A(aila!ility of 9are) *acilities and Ser(ices. April 0$$$
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