Sample Older Adult Assessment and Comparison Essay – Alzheimer’s Disease and Chronic Obstructive Pulmonary Disease (COPD) Paper

Sample Older Adult Assessment and Comparison Essay – Alzheimer’s Disease and Chronic Obstructive Pulmonary Disease (COPD) Paper

Older Adult Assessment and Comparison Paper

Introduction

Pushing limits in health care, creating awareness, educating the community of older persons and the setting of goals by Healthy People 2020 we are going to see a tremendous number of people over the age of 65 living longer.  With the increased life expectancy comes greater demand of care for this population due to the increased needs that are going to be identified.  Not only does this put increased burden on health care to find the resources, knowledge and expertise to care for this population, but it makes this population more vulnerable to adverse outcomes.  The older population when looking at authors Flaskerud and Winslow’s Vulnerable Populations Conceptual Model addresses this population’s increased risk of vulnerability related to their health status, relative risk factor, and resource availability (Allender, Rector, & Warner, 2014).

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            As one ages they are typically exposed to more risk factors that may negatively impact their health.  Their health may suffer from those risk factors or lack of care related to the availability of resources or lack of that they have had throughout their life thus far.  As one’s health declines not only do they need resources to be treated, but they need transportation, support, financial means, and so forth.  These resources are scarcer due to the increased demand there are just not enough, and the older population in many cases are retired with little knowledge of how to access the resources that are available to them.  This population is only growing and needs education on primary, secondary, and tertiary prevention methods, in addition to resources available and help accessing them.

Older Adult Assessment Tools

With my Grandpa John we went through a few of the Older Adult Assessment Tools to establish what additional resources that he might need and interventions that we could implement together to better keep him safe.  Upon completion of the UW Elder Initiative Basic Older Needs Assessment I established that my grandpa is in need of many resources and is putting a lot of strain on my grandma to care for him.  From the assessment I found that grandpa was diagnosed with late onset Alzheimer’s disease and COPD which he has had for years and is taking a few new medications that my grandma is administering.  Neither of them are educated on what they are or how these medications work.  Currently he is becoming more frail and deteriorating quickly.  Now he is functioning like he is 20 years old, which was when he was an alcoholic.  So he has experienced many personality changes recently, which is very upsetting to grandmother.   He has become more violent, with outbursts; he is angry and often restless.

His functional limitations are starting to waiver from day to day.  Occasionally my grandfather needs assistance using the restroom and ambulating, but it is not a constant thing, neither are his outbursts.  When it comes to meal preparation, house work, paying bills, and transportation my grandfather is not able to do any of that.  He is still able to feed himself, dress, bath and participate in his normal hygiene routines it just takes him longer than it used to.  My grandpa is retired and has been for about 15 years, my grandparents are just above the poverty line, but our family just helped them pay off their house.  They are on Medicare and my family assists them with food and any other bills.  Overall my grandpa said that my grandma does everything, but my grandma stated that she does that now but knows she can’t do it forever.  My aunts have been taking turns going over during the week and driving my grandparent’s places, helping with chores, and making meals.  From this assessment though my grandpa needs more help than what my grandma can give him, it is starting to take a toll on her health.

After completing the Fulmer SPICES: An Overall Assessment Tool for Older Adults with my grandfather I noticed it was more vague than the UW Eldercare Needs Assessment.  Going through it with my grandpa I found that he occasionally has problems with eating and feeding, incontinence, and confusion.  So from this understanding my grandpa is experiencing a few geriatric syndromes according to authors Inouye, Studenski, Tinetti, and Kuchel (2007).  Urinary incontinence and functional decline are both present currently which are predicted to only become more of an issue in time because of his Alzheimer’s diagnosis and rapid progression.  Furthering that notion he has been experiencing minor issues with mobility that may become major problems increasing his risks for falls, which is another geriatric syndrome (Inouye, et al, 2007). This area of prevention has been discussed with my grandmother and my aunts.  My grandpa told me that his confusion comes with change in his patterns and new people.  So all of these limitations are not an everyday thing, but are beginning to happen more frequently.  He told me that he had no evidence of skin breakdown after I explained what that was to him.  This is a potential geriatric syndrome to watch for due to his decreasing mobility that may eventually lead to limited or no mobility (Inouye, et al, 2007).  We talked about that and how to avoid it, my grandma was present when we talked about this.  He has also had no falls and is not experiencing any sleeping issues that he only gets up at night if he has to use to restroom.  This is also where the incontinence comes from he does not always make it to them bathroom in time or at all at night.  So we talked about not drinking any fluids about an hour before bedtime and using the bathroom before getting into bed to help with this.

Next I went over the Family Assessment Tool while talking with my grandpa John.  I included my grandpa and grandma in the family constellation because they are living together within the home and my grandma is doing most of the care for my grandpa as needed.  I answered the questions based on my own judgments from the conversations that we had throughout the day.  The first category is Facilitative Interaction among Members, overall there communication with one another is good, but I would say that they need work on resolving conflicts and being supportive of one another.  My grandma is trying to be very supportive, but is struggling from caregiver strain which is causing the conflicts.  She just needs help; it is getting too overwhelming for her to do most of the care by herself.

In the Enhancement of Individual Development I noticed that my grandma is not quite accepting of my grandfather’s total diagnosis and neither is he.  Due to this lack of acceptance my grandpa is not always acknowledging certain tasks he should not be involved in because they stir up confusion and my grandma is then over bearing trying to do too much and taking away the autonomous activities that he should be doing to keep them intact as long as he can.  In the Effective Structuring of Relationships decision making is being allocated to appropriate members for the most part, but my grandma is not distributing tasks to my grandpa flexibly.  Both of my grandparents are not actively coping properly.  They are not making all the necessary changes due to lack of acceptance of the change being needed; they are not utilizing resources neither are they accepting new ideas and proposals from others about help.  The living conditions are safe and hygienic my aunts have gone over to the house and organized the house for clear paths and to help prevent falls.  They also take turns cleaning the home.  The emotional climate is unsteady at times though with my grandpa’s outburst and my grandma’s caregiver strain.

Overall my grandpa likes to take walks, but my grandma is not always accepting of this because she is afraid something bad will happen.  This is an intervention that we discussed is healthy for both of them, but that could be done with my aunts or other neighbors if she does not feel comfortable walking with him by herself.  Overall my grandparents have very little links with the community the moved from Florida two years ago and have not connected with the community where they live now.  They also lack any information and education about community resources and involvement.  My aunts and I have discussed the importance of them getting involved especially my grandma so she makes some connections and friends to cope better if my grandpa does pass away soon.

When I got to the CDC Check for Safety A Home Fall Prevention Checklist my grandparents recognized it already.  I told them that we were going to go over it and they said that my aunt got it from the doctor and went over it with her.  So we talked about and checked to make sure everything was still up to date on it.  All of their rooms are very open, the floors are clear and the furniture is out of the way of their paths.  They do have non-skid rugs on the floor because they have wood floors, which I discussed that they should be wearing non-skid socks or non-slip shoes if they are walking around the house then.  They only have steps on the outside of their home; the house is a one story.  The stairs outside are in good condition, cement newly poured, with no debris, and two handrails on either side.

My grandma does utilize the high shelves in her kitchen, but said she just got a new stepping stool.  I still discussed with her possibly moving the common items that are up high to move down to lower areas.  They already have non-slip rugs in the bathroom, but are in need of grab bars for the shower and the toilet.  We discussed this with my Aunt Julie and her husband was going to come over and install those.  They have night lights all over the house and both of my grandparents have easy to reach lighting near the head of their bed.  As we already discussed walking is important and my grandpa likes doing that so having my aunts come over and help them do that a few times a week if not every day is important.  Both of my grandparents have glasses and get their vision checked yearly, and I discussed medication with my grandma for better understanding.  I am glad we went over this because they were in need of grab bars, but other than that they were up to date with everything else.  This did prompt our family also though to consider looking into getting them an alarm device in case they fall and are not able to get up and call anyone.  I left a copy of this checklist with them in case, so that they could go over it whenever they had any changes just to be safe.

Next I went through the Improving Independence in the Home Environment: Assessment and Intervention Tool and discussed possible interventions with my grandpa.  In the bathroom potential problems are the toilet getting up and in the shower not having railings so increasing the risk of falls.  As discussed before my uncle is going to come over to the house and install grab bars in the shower and in front of the toilet.  In the bedroom and throughout the house the flooring is wood, so non-slip rugs have been placed, but wearing non-slip shoes with rubber soles or socks with rubber grips needs to be done as well.  Medications are also an issues with my grandpa he can’t read the bottles because the print is too small and he has some memory loss.  He gets confused when it comes to his medications so my grandma usually deals with that. However I wrote out the instructions of his medications, common side effects, and when to take them so that he could read it.  I also instructed him that he could use a magnifying glass, which they already have.  I educated my grandma on his medications as well as hers because including the caregiver is just as important, especially since she is able to explain his medications to him whenever he may be confused and forgets about his medications (Marck, et al, 2010).  I made sure that they both were aware of what they were taking, why they were taking it and the side effects of their medications.  After the assessment I was able to identify where the main medication issues were and found that it was when to take each medication (Marck, et al, 2010).  To make it easier for my grandma and help my grandpa be more independent of his care I organized a weekly pill box and sorted of his medications for days and times to ensure they were taken properly.  I talked with my aunts and they are going to refill the medication box when they go over every week.  My grandma was also instructed on how to do this if one of my aunts wasn’t able to make it over during the week.

In the kitchen when carrying items I instructed my grandpa to slide stuff across the counter as much as possible.  If they have anything really heavy or hard to manipulate I instructed my grandparents to call someone to come and help them not to move it themselves.  There is also one very low chair located in the living room that my grandpa loves to sit in.  I put pillows on the seat of it to raise it up to make it easier for him to sit and get up.  He said this helped him; he is over six feet tall so I’m sure it helped a little.  I also explained to him to use the armrests to help him when he is getting up.  My grandpa has some hearing loss so it is hard for him to hear everything; the phone, television, and alarms.  So I talked with my grandpa and aunts about getting him hearing aids and in the meantime found a ringtone that he could hear better than others.  We also preset numbers on the phone for my aunts, emergency numbers, and my dad to make it easier when they need to call someone.  For the alarms we also discussed having my uncle install alarms that have lights to help alert my grandpa.  We talked about the front door being difficult for my grandpa to identify people, but my grandma said this was due to confusion and memory loss and that an intercom wouldn’t help.

From the information gathered in the Assessment Tools my grandpa is in need of a few referrals and attention to CDC guideline regarding physical activity was addressed.  I recommended that my grandpa get his hearing checked out, I definitely believe that he would benefit from hearing aids and I collaborated with family to get this done.  In addition according to the Center for Disease Control people over the age of 65 years old need 150 minutes of moderate exercise (ie. walking) a week and need muscle strengthening 2 or more times a week. Throughout the assessments we did discuss walking with neighbors or my aunts when they come each week to get this exercise in.  My grandpa likes doing it; it is just a matter of coordinating it with someone who is able to walk with him safely.  The muscle strengthening could be done with a trainer at a gym in the community.  My aunts attend the YMCA so I discussed possibly taking him twice a week, he would need to take it slow so working with someone who is trained would be safer for him (CDC, 2014).  According to Healthy People 2020 maintaining social relationships and interactions is very important for elderly with Alzheimer’s in order to keep them functioning optimally for as long as they can.  Keeping the client engaged in their activities of daily living is also very important so I discussed this with my grandma so that she will allow him to do as much as he can on his own (Healthy People 2020).  I asked my grandparents to think about hobbies or something that they liked that they would be interested in doing in the community and they both stated they would rather just go to the gym as previously discussed.  My grandpa was recently in the hospital and at that time he received the pneumococcal and influenza vaccines.  He is up to date on his immunizations according to the CDC however; my grandma is not up to date which could put both of my grandparents at an increased risk.  I educated my grandma on this and she told me she doesn’t like needles.  I explained they didn’t hurt much and that it is more important to get vaccinated then not.  So she agreed to get her vaccinations the next chance she got, so I then discussed this with my Aunt Julie who usually takes my grandparents to the doctors.

Compare and Contrast

            PACE, Transition, and NICHE are all Models of care aimed at improving persons over the age of 65’s care.  They all established resources to help the older population with chronic diseases receive care in the community and set goals to make sure that care was more than adequate.  All of the Models focus on innovative evidence based clinical practices and have continued education opportunities as well as continued research efforts in geriatric care.  In addition all of the Models are in different stages of operation and are paid for differently.  The PACE Model is paid for by Medicaid, Medicare, and grant funding (National PACE Association, 2002).  The NICHE Model is paid for by hospitals that chose to use incorporate this education model into their practice and the Transitional Care Model is paid for individually or few through the Affordable Care Act’s Pilot funding (Initiative on the Future of Nursing, 2011).  These Models focus on different care providers in specific.  PACE discusses more physicians as providers, whereas the other two models focus more on nurse’s role in geriatric care.

The PACE Model of care is an all-inclusive approach that looks at all aspects of care that the older population may need while still in the home, or in facilities within the community.  In addition this model focuses on keeping the client within the home although they must qualify for needing nursing home care in order for PACE to work with collaborating community services for the client (National PACE Association, 2002).  The PACE Model focuses on preventative care versus acute care so that the client may stay within the home for as long as possible.  Whereas NICHE is a model aimed at patient centered care of the older population in the hospital setting.  NICHE established the Geriatric Resource Nurse model to educate staff nurses on geriatric cases so that they can be the resource nurse for their entire floor (NICHE, 2014).  This is the most frequently used NICHE Model, which has helped improve the older population’s patient outcomes and satisfaction with their hospital stay.

In addition NICHE also developed the Acute Care of the Elderly Patient on a Medical Surgical Unit model.  This model commonly known as ACE focuses on patient centered care of older populations trying to prevent further geriatric syndromes and educate nurses on geriatric care to improve the elderly client’s outcomes (NICHE, 2014).  While the NICHE Model focuses on hospital care of the older population the Transitional Care Model focuses on the discharging and reintegration of the older client going home from the hospital. This model identifies what needs the client has when transitioning from the hospital to home collaborating care within the community to meet these patients’ needs so that they can stay out of the hospital.

While all three models PACE, NICHE, and Transitional Care focus on education of the older population and meeting the diversity of their needs, each of these models focuses on education within certain ranges of care.  The PACE Model focuses on care of the older population prior to hospitalization or chronic health issues flaring up, thus this is primary prevention.  This model though also focuses on secondary and tertiary prevention when clients are admitted to nursing homes or hospitals.  The NICHE Model focuses on education during the acute phase of the disease, or while the older client is in the hospital receiving care so this is secondary prevention.  Then the Transitional Model focuses on tertiary prevention through educating the client and family on recognizing symptoms that may lead to further complications.  This is done to prevent further readmissions to the hospital while encouraging active participation and compliance with the designed plan of care.  Each of these Models discussed promote transitions into care of the next model.  The PACE Model if necessary transitions those older populations to move into the nursing home or be hospitalized, then provides the collaboration of care within those settings. Whereas the older population receiving care within the hospital moves out of the NICHE Model into the Transitional Care Model upon discharge.  Those Models at the end of care overlap tasks with one another.

Each of the models focuses on different guidelines that suite there area of implementation.  The PACE Model focuses on guidelines and recommendations for common chronic issues that the geriatric population experiences.  The PACE Model Practices are; diabetes mellitus, chronic heart failure, chronic kidney disease, and obstructive pulmonary disease (National PACE Association, 2002).  These model practices have guidelines for PACE physicians to use when planning treatment and prevention strategies.  Guiding Principles for the NICHE Model are hospital focused which include; geriatric evidenced based bedside care, patient family centered environments, healthy and productive practice environment, and metrics of quality.  Then the Transitional Care Model focuses on a continuum of care from screening, managing symptoms, then collaborating and coordinating care of these clients (Initiative on the Future of Nursing, 2011).

After reviewing the different models the one that I find most appropriate in using with my older adult is the PACE Model.  I found that this would be the most affordable, but would also provide more benefits for my older adult because it is an all-inclusive approach.  This model focuses on keeping the client within the home for as long as possible, which I feel would be best for my older adult overall.  Providing primary prevention to prevent further complications would be important to prevent my older adult from being admitted to the hospital.  These include staying hydrating, eating healthy and avoiding falls as we discussed during our assessment.  It would focus on the health issues that he currently is experiencing with his Alzheimer’s.  This would be beneficial in ensuring medication compliance and that my older adult is getting his medications and medication box refilled as needed every week.  It would also follow through with his care if he transitions to a nursing home at some point, which I do believe will happen at some point due to the caregiver stress and inability to care for his increasing health demands.

Conclusion

Upon using the multiple assessment tools with my older adult I was able to find which assessment tool yielded better information from my older adult.  The UW Eldercare Needs Assessment Tool helped me identify all of the issues that were established within the other assessment tools.  From the open ended questions used in the UW Eldercare Needs Assessment my older adult went more in depth than with the other assessment tools.  However the other assessment tools were beneficial in identifying interventions appropriate for my older adult.  In addition from doing the comparison of the three models of care; PACE, NICHE, and Transition I found that the PACE Model best met the needs of my older adult.  This assignment helped me identify priority safety issues that needed to be addressed immediately with my older adult.  It also brought up educational opportunities and made me aware of the future care needs that my grandfather is going to need.  Overall this assignment furthered my knowledge on older adult assessments, needs and resources available to them.

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References

Centers for Disease Control (CDC). (2014). Adult Immunization Schedules. Retrieved from http://www.cdc.gov/vaccines/schedules/hcp/adult.html

Centers for Disease Control (CDC). (2014). How much physical activity do older adults need? Retrieved from http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

Healthy People 2020. (2011b). Dementias, including Alzheimer’s disease. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=7

Initiative on the Future of Nursing. (2011). The Transitional Care Model. Retrieved from http://www.thefutureofnursing.org/resource/detail/transitional-care-model

Inouye, S. K., Studenski, S., Tinetti, M. E., & Kuchel, G. A. (2007). Geriatric syndromes: Clinical, research and policy implications of a core geriatric concept. Journal of American Geriatric Society, 55(5), 780-791. doi: 10.1111/j.1532-5415.2007.01156.x

Marck, P. B., Lang, A., Macdonald, M., Griffin, M., Easty, A., & Corsini-Munt, S. (2010). Safety in home care: A research protocol for studying medication management. Implementation Science, 543-51. doi:10.1186/1748-5908-5-43

National PACE Association. (2002). What is Pace? Retrieved from http://www.npaonline.org/website/article.asp?id=12&title=Who,_What_and_Where_is_PACE?

NICHE. (2014). The NICHE Program. Retrieved from http://www.nicheprogram.org/program_overview

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