Comprehensive Scholarly Paper Gerontology is the scientific study of old age, the process of aging, and the particular problems of old people. With maturation the elderly suffer from age- related changes that effect their overall health and day to day living. Even those these changes provide limitations that can be lived with, these changes can also exacerbate many medical conditions. The elderly client I decided to evaluate, H. J. is a 76 year old african american female, that has a past medical history of chronic heart failure, myocardial infarction, hypertension, asthma, and renal mass.
H. J. also has a past surgical history of a left mastectomy. She is retired and lives at home by herself and has one daughter. Some of her medical conditions are definitely effected by age as well as lifestyle. With age the heart and blood vessels undergo many changes. In the heart with age the SA node loses some of its cells, this may result in a lower heart rate. Abnormal rhythms such as atrial fibrillation, these arrhythmia are often due to heart failure. Hypertension in the elderly is also common. With an increase in age the systolic blood pressure can increase up to 20 mmHg on its own.
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The baroreceptors become less sensitive with aging. This may explain why many older people have orthostatic hypotension”. With all of these heart changes it is important that the elderly are educated about lifestyle changes. While H. J was a patient in the hospital she ordered a heart healthy diet, which helps control blood pressure and cholesterol. The patient also had a history of a stroke, which also has to do with lack of blood flow to the brain. The prevalence of all these medical conditions increase with age when the elderly are not properly taking care of themselves.
It is important to be eating a healthy diet, exercising, and refraining from the abuse of substances. By this client being a previous intravenous drug abuser she is even more exposed to complication. Drug abuse can, “cause cardiovascular conditions ranging from abnormal heart rate to heart attacks. Injected drugs can also lead to collapsed veins and infections of the blood vessels and heart valves”. There are many considerations when it comes to medications and the elderly. Age-related changes often affect the action and availability of the medications in the body.
Many of the elderly are also non-adherent to medication. For example although H. J was administered several medications in the hospital such as lovenox, protonix, Plavix, bactroban, methadone, and multivitamins, there was no list of medications in her file for reconciliation and I am almost certain it is because she refuses to take them. Just in that day I witnessed her refuse several medications as well as labs, while in the hospital. Following her many hospital visits she has been ordered several medications to be continued at home, but does not want to take them for her own ersonal reasons.
There are many factors that can contribute to non-adherence which include; depression, cognitive impairment, isolated living conditions, finances, beliefs, adverse effects and knowledge deficit. It is likely this patient did not want to about how much the medicine could help her if she did take it. The medicine she was sure to take was her methadone. Methadone is mainly given to patients who suffered from a drug dependency and causes irritability when in between doses. Drug users who are struggling with a dependency definitely have a cognitive impairment and are ot often thinking with a clear head.
Polypharmacy is also a issue with the elderly because of drug interactions. The elderly are more at risk for medication-medication interactions due to the fact they are prescribed so many medications. H. J did not have many functional limitations documented on her chart. She was able to feed herself without assistance, but did require assistance getting to the bedside commode. Since she is unable to get to the restroom alone in the hospital, it is a wonder how she maintains living at home alone. With her ambulation problems he is definitely at risk for falls at home. “Each year, one in every three adults age 65 and older falls.
Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death”. It is important to teach older adults who live at home alone how to decrease the risks of falls. They must remove tripping hazards such as rugs, improve lighting, and add grab bars where needed. Instrumental activities of daily living would be even more difficult to complete for H. J. Assessment of her functional status in the hospital showed that some level ssistance would be necessary at home to complete tasks such as medication management, transportation, and bathroom assistance.
Upon assessment I did observe some cognitive impairment which I believe was due to the effects of medication. Prior to the administration of methadone H. J was very uncooperative and unable to answer basic questions related to pain rating and orientation. She did not want to be bothered or assessed at all. About an hour and a half later following her medication administration she was much more talkative playful and willing to answer any questions I had to ask. She was also even willing to explain why she refused her MRI which was due to claustrophobia. Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications. This reflects age- and disease-associated changes in brain neurochemistry and drug handling”. The client felt very relaxed and at ease when her daughter came to visit. H. J was even more lively and at ease when her daughter came to visit. Family support is very important to the elderly. “Without family visits or attention, the elderly may fall into a depression, or feel all alone. A big part of any elder care program is to give emotional support.
Studies show that this can improve life expectancy by several years, and create a more positive and optimistic environment for the aged”. H. J lives independently at home, but with the amount of assistance she requires in the hospital setting revealed that assistive devices such as a cane or walker may be necessary. After observation I also think it would be a excellent idea for her to move in with a family member or live in a assisted living facility if someone in the family is unable to provide care. Many elderly people will live without assistance until it is offered or they are hurt.
Transitioning from independent living to assisted living can be difficult. It is important to remind the client that they are not being stripped of their independence. include educating her. Most of her issues, such as refusal of medication stem from not being educated on how medication and lifestyle changes can help with her overall health. Many elderly clients are “set in there ways” and are not educated about modern methods of treatment. None of the nurses really explained to her why he should get the MRI or take lovenox when she refused them.
Sometimes a personal relationship needs to be built, so that a client can understand you genuinely have their best interest at hand. Physical therapy would also be a recommendation. Physical therapy is a non-medicinal method to increase strength, flexibility, range of motion, endurance and alleviate pain. Falling is such a big risk for the elderly, physical therapy puts patients at a lower risk for falls. People often are unsure about physical therapy because of the financial aspect, but some Medicare nd Medicaid plans cover the costs.
I would also recommend another type of housing option. A continuing care retirement community or assisted living facility would be good options. They both offer nursing home care, however a assisted living community would go a little further and offer meals, social activities. Having elderly clients transition from a independent home setting to an assisted living facility can be difficult and also is sometimes associated with a negative image, but it is important to explain to the client how much safer it is. Their are many myths about age.
People believe that with age decline is inevitable, but it is important to remember that regardless of age every elderly person should have the right and opportunity continue to live a safe, comfortable, and enjoyable life. And even with decline there are many options out there to make sure there is good quality of life available to patients that are suffering. References Aging changes in the heart and blood vessels: MedlinePlus Medical Encyclopedia. (2012, September 4). U. S National Library of Medicine. Retrieved December 9, 2013, from http://www. nlm. nih. ov/medlineplus/ency/article/004006. tm Aging changes in the kidneys and bladder: MedlinePlus Medical Encyclopedia. (2012, November 10). U. S National Library of Medicine. Retrieved December 9, 2013, from http:// www. nlm. nih. gov/medlineplus/ency/article/004010. htm Falls Among Older Adults: An Overview. (2013, September 20). Centers for Disease Control and Prevention. Retrieved December 9, 2013, from http://www. cdc. gov/homeandrecreationalsafety/ falls/adultfalls. html Feature, W. (n. d. ). Physical Therapy a Boon for Seniors. WebMD. Retrieved December 9, 2013, from http://www. webmd. om/healthy-aging/features/ hysical-therapy-benefits-for-seniors Miller, C. A. (20122012). Nursing for wellness in older adults (Sixth ed. ). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Moore, A. (1999, July 15). Result Filters. National Center for Biotechnology Information. Retrieved December 9, 2013, from http://www. ncbi. nlm. nih. gov/pubmed/10459729 The Importance of Family Support for Elderly Well????? Being. (2011, April 27). San Diego Home Care. Retrieved December 9, 2013, from http:// homehealthcaresandiego. wordpress. com/2011104/27/the-importance-of-family- support-for-elderly-well-being/