Healthy Aging and Chronic Conditions

The purpose for this case study essay is to enable students to produce a nurse-led case discussion of an older adult, using evidence-based information relevant to nurses and up-to-date Australian statistics, for improving the health and quality of life for elderly persons who have multiple comorbidities and care needs. Content should include discussion on the questions provided in the case study using a holistic approach.

Case study

Theodore Papadopoulos is an 83-year-old gentleman with a rich Greek background. He migrated to Western Australia when he was 45 years old and ever since has lived and worked in Australia. Mr Papadopoulos is a builder by trade and has at times worked on constructions sites where he was often exposed to noisy and polluted environments. He is a widow who lives alone in his unit situated within a retirement village. While Mr Papadopoulos has access to services and social events within the retirement village, he tends to remain on his own especially since his wife died two years ago. Mr Papadopoulos has a keen interest in sporting events and on migrating to Australia continued his religious connections by attending a Greek Orthodox Church and the Hellenic Community. Mr Papadopoulos enjoys Greek cuisine and has a ritual of making himself a Greek coffee every day at morning teatime. He has two daughters Katerina and Dimitra who live some distance away and have not been overly involved in his life due to extensive work commitments, that is up until his recent diagnosis of dementia last month. Recently Mr Papadopoulos presented to emergency department (ED) via ambulance following a fall. He fractured his left NOF and has been to the operation theatre (OT) for a total hip replacement (THR). He is now day 7 post op. Mr Papadopoulos has a medical history of osteoarthritis, constipation, cardiovascular disease and transient ischaemic attacks. He has chronic obstructive pulmonary disease and NIDDM for ~ 20 yrs. There is indication that Mr Papadopoulos is in pain, but it is yet to be established as to whether this is related to the diabetes, osteoarthritis or both conditions. Since he lost his wife, Mrs Papadopoulos, his daughters report that he is self isolating and query whether he is depressed. He wears bilateral hearing aids and glasses for his vision impairment related to glaucoma, cataracts, and diabetic retinopathies. During his stay in acute care ward, the nurses noted that Mr Papadopoulos is: – Underweight – Dishevelled and dehydrated indicating possible neglect – Breathless – Grimacing and wincing during transfers and repositioning – Unable to report as to whether he has used his bowels in the past four days – Confused, possibly hallucinating causing significant distress for his daughters – Hard of hearing and reluctant to wear his hearing aids After nine days in acute care ward and three weeks in rehabilitation ward, it was questionable as to whether Mr Papadopoulos could continue to live independently. After discussions with the interprofessional health care team, it was decided that Mr Papadopoulos could return home with community services in place. Mr Papadopoulos’s two daughters Katerina and Dimitra were advised that should he be unable to cope at home they may need to consider residential care placement for him.

Questions

1. Discuss multicultural ageing in Australia, provide some statistics about cultural diversity in Australia. In your discussion consider the case study of Mr Papadopoulos and explain why nurses need to be culturally competent and culturally aware when supporting someone from the Greek community (approx. 150 words).

2. Consider the case study of Mr Papadopoulos. His daughters are increasingly concerned about his care requirements following discharge in particular his increasing risk of further falls and ongoing deterioration in his memory loss. Discuss health literacy and consider why is it important when supporting Mr Papadopoulos and his daughters upon discharge. (approx. 150 words).

3. Consider and discuss any pain that Mr Papadopoulos may be experiencing. What assessments will you undertake and what actions will be implemented to reduce/eliminate the pain (approx. 150 words).

4. Currently there is a changing paradigm in how people with dementia can best be supported with an increasing emphasis on helping the person to sustain wellbeing and independence. What information will you provide to Mr Papadopoulos’s daughters on the day of his discharge so they can help him to live well? (approx. 150 words).

5. The nurse caring for the older person needs to be well informed about delirium. What are the indications that Mr Papadopoulos maybe experiencing delirium? How will the nurse assess this and how will the nurse best support him? (approx. 150 words).

6. When supporting an older person to live well the nurse and family member need to consider the continuum of care. What does this mean and how does it relate to the case study of Mr Papadopoulos? (approx. 150 words). 7. Mr Papadopoulos’s past medical history indicates that he suffers from a respiratory condition. What are the aged-related changes associated with the respiratory system that may exacerbate respiratory disorders in the older person? How can the nurse help the patient with a respiratory disorder maximise their respiratory health? (approx. 150 words).

Answer

Healthy Aging and Chronic Conditions

Aging is an inevitability of life that inspires an ambivalence of perspectives, with some seeing it as a pleasant experience and others viewing it as a tragedy. The latter may be ascribed to the loss associated with aging—the loss of loved ones, financial independence, vitality, and mobility. Although there are several classifications for this demographic, many studies categorize elderly persons between the ages of 65 and 74 as the youngest-old, those between the ages of 75 and 84 as the middle-old, and those above 85 years as the oldest-old (Lee et al., 2018). Theodore Papadopoulos, the 83-year-old patient described, fits into the middle-aged group, accounting for 1.7% of the population in Western Australia aged 80-84 years (Australian Bureau of Statistics, 2018). Aging increases the risk of multiple comorbidities, including cardiovascular disease, diabetes, chronic obstructive pulmonary disease, cancer, and osteoarthritis, among others, due to waning immunity, long-term exposure to hazardous materials, and long-term engagement in health-risk behaviors such as smoking and alcohol consumption. Treatment of the aged population, therefore, involves a healthcare professional who understands the population’s health and social requirements and designs age-appropriate treatments. The purpose of this paper, with reference to Theodore Papadopoulos’ case study, is to address multicultural aging in Western Australia and, more broadly, the plight of the elderly.

Question 1: Multicultural Aging in Australia

The economic and social makeup of the older population, especially the culturally and linguistically varied population of Australia, is critical for strategic planning at all levels of government. Australia has one of the world’s most culturally diverse populations, with one in every four of the country’s 25 million people born overseas, 46% having at least one parent born overseas, and approximately 20% of Australians speaking a language other than English at home (Australian Bureau of Statistics, 2022). In 2013, overseas migration accounted for 60% of Australia’s population growth, and Greek ancestry, to which Theodore Papadopoulos belongs, is one of the largest ethnic groups, accounting for over 375000 people (Australian Bureau of Statistics, 2022). Greeks face prejudice in Australia since they are an ethnic minority, and certain races may perceive them as inferiors. Furthermore, Greek immigrants may experience difficulties obtaining health and social services, as well as finding work, and hence may be financially grotesque. As a result, nurses providing care to the elderly Greeks must be culturally competent to comprehend their plight and provide appropriate treatment.

Question 2: Health Literacy

Information is a crucial determinant of health behaviors. Liu et al. (2020) define health literacy as the capacity of people to find, comprehend, and use information and services to guide health-related choices and behaviors. Mr. Papadopoulos is an 83-year-old patient who may be experiencing cognitive deterioration due to age or his recent diagnosis of dementia, which may jeopardize his health literacy. He also has hearing and vision problems, which may restrict his capacity to learn new health information. A nurse must consequently explain to Mr. Papadopoulos’ daughters how to care for the patient at home upon discharge. Mr. Papadopoulos will need assistance with medications, movement, hygiene, and turning on the bed to avoid pressure ulcers, all of which the nurse must explain to his daughters. Adherence to healthy habits and assistance with many aspects of everyday life will hasten his recovery.

Question 3: Pain, Assessments, and Actions

Pain may be a challenging symptom to assess and treat in the aged population due to the various illnesses that may exist concurrently and induce pain independently of each other. It is unknown if the patient’s pain is caused by diabetes, osteoarthritis, or both. Diabetics, especially those who have had the illness for a long time, such as Mr. Papadopoulos, have advanced glycation end products (AGEs) deposited on nerves, leading to neuropathy, which causes pain, numbness, and tingling sensations (Papachristou et al., 2021). Furthermore, degenerative disorders such as osteoarthritis are major causes of pain in the aged population. Physical examination, including gross light touch and pinprick sensation, is required to examine the patient for peripheral neuropathy. Doppler and angiography may be performed to check for ischemia, and laboratory testing may include random blood glucose, complete blood count, and hemoglobin A1C. Plain radiography of the suspected joint is essential for assessing osteoarthritis. Diabetic neuropathy is managed using a tier system that includes paracetamol, amitriptyline, duloxetine, gabapentin, or pregabalin, with opiates as the final resort (Cernea & Raz, 2021; Penman et al., 2022). Non-pharmacologic therapies such as physical therapy, pharmacotherapy such as NSAIDs, and surgery as a last option, such as arthroscopy, osteotomy, arthroplasty, or fusion, will be required for the management of osteoarthritic pain (Bannuru et al., 2019). To improve pain relief, his loneliness and mental health issues must be addressed.

Question 4: Information on the Day of Discharge

Patients with dementia, alongside other medical comorbidities, may suffer twice as much since the condition causes severe cognitive deterioration. Learning and memory, language, and social ability may all deteriorate. Furthermore, dementia patients have severe interference with independence in daily tasks such as work and cleaning, necessitating the aid of close family members (Tisher & Salardini, 2019). While discharging the patient, I will implore Mr. Papadopoulos’ daughters to assist him with medication adherence (antidiabetic meds, pain medications, etc.), cleanliness, and daily blood glucose measurement. Furthermore, I would advise them to prioritize nutritional care since their father exhibits signs of neglect (underweight, untidy). Moreover, since Mr. Papadopoulos is in danger of suicide due to loneliness and neglect, I would counsel his daughter to be as near to him as possible to offer him a feeling of love and belonging.

Question 5: Delirium and Assessment

In an emergency setting, delirium is easily mistaken for other medical problems. According to the American Psychiatric Association (2013), the fluctuation in attention and awareness is the hallmark of delirium. The disturbance in attention develops over a short period, usually hours to a few days, and other cognitive disturbances may be present, impacting memory, language, and perception (APA, 2013). In the acute care ward, Mr. Papadopoulos is unable to report if he has used his bowels in the last four days, and is confused, which may correlate to delirium symptoms of disrupted attention and cognition. Delirium is an organic brain syndrome that has multiple causes. As a result, the nurse must do a comprehensive assessment of the patient to discover the cause of the delirium. Physical examination of all systems, evaluation of the history of drug addiction and modifications the patient is on, and laboratory testing such as complete blood count, urea, and electrolytes are among the assessments important in delirium (Lauretani et al., 2020). Helping the patient depends on the etiology of delirium, where medications, drug withdrawal, or just supportive care such as hydration and nourishment may be necessary.

Question 6: Continuum of Care

Care for the elderly needs the collaboration of various care professionals, as well as the patient and their family members. According to Thapa et al. (2020), a continuum of care is a notion that involves an integrated system of care that leads and tracks patients through time via a broad array of health services covering all levels of intensity of care. Mr. Papadopoulos will use health services and interact with healthcare specialists frequently since he has various diseases that need lifetime care. To ensure that his treatment runs well, care professionals must include the patient and his family in the care process. This may be accomplished via regular physical encounters like clinic visits or through virtual interactions like telephonic calls, live audio-visual teleconferencing, text messaging, and other telemedical platforms. The technique is especially crucial for Mr. Papadopoulos in blood sugar management, where blood sugar measures will be taken and forwarded to their primary care physician, who will subsequently respond with further care guidance.

Question 7: Age-Related Changes in the Respiratory System

Aging is often associated with a decline in bodily system function. Peak airflow decreases with age, as do other measures of lung function such as vital capacity, the respiratory muscles weaken, and the efficiency of lung defense systems declines (Lin et al., 2020). The alterations make one more susceptible to respiratory diseases or worsen the effects of respiratory ailments. Patients may have decreased exercise tolerance as a result of decreased lung function and weakening respiratory muscles. To improve their respiratory health, the elderly may benefit from respiratory physiotherapy and incentive spirometry, which expand the lungs and allow patients to breathe more deeply and thoroughly (Eltorai et al., 2018; Rodrigues et al., 2020). Furthermore, patients must refrain from risky health behaviors such as smoking, which increases the risk of lung cancer and weakens their immunity, rendering them prone to respiratory infections.

Conclusion

Australia boasts one of the world’s most culturally and linguistically diverse populations. The diversity is due in part to a large number of immigrants from other countries, each of whom retains and practices their own culture. Mr. Papadopoulos’ Greek origin is one of the great ethnic minorities that have lived in Australia since antiquity. As a minority, they confront barriers to health and social services due to cultural disadvantages. As a result, healthcare practitioners must comprehend this group’s challenges and devise age-appropriate health and social interventions to address the concerns.

 

References

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