Abstract
The health issues affecting older people have over the years faced constant ignorance in the society. It has become essential to include the elderly patients in the national policy issue because of their increased numbers in the population. The primary objective of such a move is to provide better health care and high quality of life for older adults and their respective families. Health care systems, health care providers, policy makers and health care organizations have to dedicate their efforts on sensitization of acute and chronic medical issues affecting older and improvising measures that can help protect the elderly adults in the society.
The primary concern of a physician or a health worker is to conduct an assessment of the elderly client and detect potential health issues that are affecting the patient. Geriatric assessment should be flexible in scope and diverse in content to serve the different patient’s needs (Entwistle et al., 2012). An interdisciplinary team performs a detailed assessment, critically analyze the assessment information, improvise an effective strategy to curb the problem, and afterward follow up on the patient progress. This article discusses the medical history of a 78 year old Mr. John Jacobs, who has both chronic and acute medical problems and proposes recommendations for improving his state.
A comprehensive Evaluation Paper
Medical evaluation of elderly people is very different from the standard medical test. Historical analysis and physical examination of older patients are done at different times because the patients become fatigued as a result of their age (Bickley & Szilagyi, 2012). Geriatric assessment focuses on collecting medical data, psychosocial, functional capabilities and limitations of the old in the society. Elderly patients usually face various medical conditions that may not be tested by the standard medical test. These conditions include; intellectual impairment, immobility, instability, Iatrogenic disorder, and incontinence.
My patient Mr. John Jacobs suffers from complicated health issues such as multiple disorders which may require the use of many drugs hence he have a likelihood of using the inappropriate or high-risk drug. If the diagnosis does not adhere to the set rules, such patients are often exposed to the wrong medical diagnosis. Early detection of a problem is essential as it will favor early detection, which will reduce deterioration and improve the quality of life of the old.
An interdisciplinary team that specializes in medicine, Psychiatry, social work and nutrition is given the mandate to analyze the patient information and perform a detailed assessment leading to improvising of intervention strategy and treatment for the patient. Mr. John has a family history of diabetes, hypertension, arthritis, bleeding tendency and heart diseases . He was diagnosed with hypertension and diabetes at 55 and later diagnosed with arthritis at 68. (Plested, 2014). John also drinks alcohol with an average of 5bottles a week and uses cigarettes occasionally. He is 5’6 tall and weighs 210pounds.
Acute and chronic medical issues
Chronic conditions among the old come with a series of disadvantages. Many older clients are forced into constant hospitalization, the transition to various nursing homes and poor quality of life (Haslbeck, Mccorkle & Schaeffer, 2012). Whereas some older individuals live an independent and active life, most of them decline into a dependence lifestyle. Chronic conditions can cause a halt in daily activities resulting in poor quality of life.
Aging of all organ cells of elderly individuals accelerates physiological change throughout the peoples' life (Clegg et al., 2013). Mr. John suffers from high blood pressure which results from a decrease in cardiac output, which one of the effects of his age. This condition has developed resulting in arteriosclerosis. Arteriosclerosis involves thickening and hardening of the walls of the artery which results in a heart complication one of the key features of the elderly patient.
John’s lungs have impaired gas exchange, a significant decrease in vital capacity and slow expiratory flow rates. As a result of these conditions, most of the my patient has breathing problems, hence needed inhalers to facilitate the breathing process. Occasionally Joh suffers from shortness of breath leading to passing out or gasping for air.
The patient's creatinine clearance decreases significantly with age. However, serum creatinine level remains relatively constant as a result of a reduction in creatinine production with age. This reduction in serotonin level results in urine abnormalities, tiredness, and diabetes. The steady increase in blood glucose level occurs with an increase in age and osteoporosis results from the linear decrease in bone mass as a person ages. Osteoporosis is a medical condition that results in bones becoming brittle and fragile from loss tissue a characteristic shown by my patient. John suffers from chronic conditions, including diabetes, urine abnormality and osteoporosis. John suffers from two types of diabetes and he rarely exercises due to his old age.
My patient Mr. John had a skin that had lost tone and elasticity. The change in skin tone and elasticity is as a result of changes in collagen and elastin, which is common in most elderly patients'. Skin epidermis wastes away as a result of age, leading to wrinkles and skin itches among the old. The epidermis of the skin atrophies with age and due to changes in collagen and elastin, the skin lose its tone and elasticity. John’s mobility and locomotive ability are inhibited by muscle loss and degeneration that occurs in joints. Most of his metabolism is altered, and he responds differently to various drugs. There is therefore an urgent need for a preventive mechanism based on diet and exercise that will help delay or eliminate some of these changes.
Medication
Older patient usually takes more drugs than their younger counterparts. As a result of this disparity older patients are having a high risk of adverse drug interaction than their younger counterparts. Both prescription and over the counter drug can cause these interactions resulting in poor health status among older.
John uses a variety of medicines to treat his medical condition, including antidepressant (SSRIs), blood pressure medication (HCTZ) and cholesterol drugs (statin) (Weber et al., 2014). If the patient does not receive proper, information about these drugs, they can cause severe interactions with the patient using them. Selective serotonin reuptake inhibitor drugs (SSRIs) increase the serotonin levels in the brain, which has an effect of reducing symptoms of depression. The patient used a variety of antidepressants, including Prozac, Zoloft, and Paxil. The drugs have unpleasant side effects and can result in life-threatening complications. Serotonin syndrome can result from the use of these drugs with a variety of painkillers, and this syndrome is life threatening. Among other side effects include suicidal thoughts and extreme drowsiness on combination with OTC drugs. John uses the SSRIs with common OTC drugs without doctor's advice leading to health complications.
In order to control his high blood pressure he usesdiuretics. One of the diuretics the patient use is hydrochlorothiazide (HTCZ). This medication pulls extra water from the body, as a result, decreases the volume of blood reducing the blood pressure. John used HTCZ with other common OTC drugs which in effect reduced the effectiveness of the medication in controlling the high blood pressure. A combination of some sweeteners and herbal tea, when used concurrently with HTCZ, results in altering of potassium levels, which can damage the heart . John uses herbal tea and this is has massive interaction with HTCZ that may lead to complications.
John uses Statins to lower the cholesterol level in the body. Cholesterol is essential for body functions, but high levels of cholesterol can lead to building up of plaque in arteries which results in blocking of blood flow and often lead to stroke or heart attacks. Statins hinder the action of chemicals in the liver that is necessary for producing cholesterol. The patient Mixes statins with a variety of dietary supplements or food which result in muscle soreness which leads to kidney failure. In addition, my patient always mix statins with oral fungal medication, vitamin B complex or grapefruit juice which is catastrophic to their health.
Functional status
Activities of daily living (ADL) represent activities that are done for daily self-care of individuals including; toileting, bathing, grooming and walking. Instrumental activities of the daily living (IADL) require a complex set of skills to perform certain tasks. Examples of IADL include managing finances, preparing meals or shopping. These two skills offer a method of gauging whether an individual can live an independent life or not.
Mental health and cognitive ability
John suffers from a variety of mental disorder, including anxiety and depression. Depression lowers immunity and may prevent someone from fighting against diseases like cancer. Depression can also result in suicide if not handled correctly. These disorders are as a result of the patient's background of divorce and family isolation. Chronic disorder results from the patient’s use of alcohol to quench his depression. John cannot perform a complex task like information handling, memorizing events and reasoning to find solutions to various problems. The patient cannot indulge actively in social activities as a result of health constraints.
Living situation
John lives alone and this affects him both mentally and physically. The patient is depressed and has a lot of stress of separation from his family leading to mental disorder. Furthermore, forgetfulness of the time to take drugs is really affecting the patient as he does not take drugs at the correct prescribed time by the physician. Isolation and leaving alone affects the client's health as it leads to deteriorating health condition over time.
Recommendation
I recommend that Mr. John gets support from family members and avoid leaving in isolation as this will reduce the level of depression and stress-related illness that may affect the person. In addition, John may get assistance at the exact time to take drugs as his memory loss is demanding. Furthermore, the patient should stick to doctors prescribe drugs and not use OTC drugs irresponsibly; this will help in preventing drug interactions. Lastly, the patient should do minor exercises to improve his physical skills and strength. Seeking a psychologist advice will help reduce mental disorders and as a result, improve the quality of life of the client.
References
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752-762.
Haslbeck, J. W., McCorkle, R., & Schaeffer, D. (2012). Chronic illness self-management while living alone in later life: a systematic integrative review. Research on Aging, 0164027511429808.
Plested, S. (2014). Alcohol use among community dwelling older adults.
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S., Lindholm, L. H., Kenerson, J. G., & Cohen, D. L. (2014). Clinical practice guidelines for the management of hypertension in the community. The Journal of clinical hypertension, 16(1), 14-26.
Bickley, L., & Szilagyi, P. G. (2012). Bates' guide to physical examination and history-taking. Lippincott Williams & Wilkins.
Entwistle, V., Firnigl, D., Ryan, M., Francis, J., & Kinghorn, P. (2012). Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map. Journal of Health Services Research & Policy, 17(2), 70-78.
.
