OLD AGE AND WELLBEING IDA ANTWI FALLS CO-ORDINATOR/CLINICAL SPECIALIST LEAD NHS HERTFORDSHIRE JUNE 18th 2012

Definition of Health “ a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This has been seen as an unrealistic goal as few people reach this ideal state of health at any point during a lifetime. Definition redefined by WHO as functional health, which is where all people should be able to enjoy a health status that allows them to participate in normal, socially and economically productive and satisfying life.

What is ill-health? Conditions of the body or mind that cause pain, dysfunction, or distress to the person afflicted or those in contact with the person can be deemed an illness. Ill health means different things to different people. How people view ill health depends on a variety of factors; if they've been seriously ill before, how knowledgeable they are about illness and also what they would class as a "severe" or "mild" illness.

Concepts of ill health Three main concepts ill health as disease symptoms– focuses on concepts associated with ill health e.g. vomiting, diarrhoea, pain, visible symptoms such as rashes, lumps on skin ill health as a subjective sensation of illness - a general feeling of being ill or unwell, also known as "Malaise". Malaise is a general feeling of uneasiness or discomfort, and is often an initial stage of an illness or disease. It is a general term for all sorts of non-visual symptoms (symptoms that are not physically apparent), such as fatigue, depression, and the general feeling of being run-down and exhausted ill health as a disorder or malfunction within the body. This usually relates to more serious and life threatening diseases illnesses, such as heart disease, intestinal blockage or a brain tumour.

General disease conditions of the elderly Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease)  Dementia, including Alzheimer's disease Depression Incontinence (urine and stool) Arthritis Osteoporosis Diabetes Breathing problems, respiratory disease Frequent falls, which can lead to fractures and trauma Parkinson's disease  Cancer 

Visual impairment, Eye problems (cataracts, glaucoma, Macular Degeneration) Gastrointestinal disorders Hearing impairment Memory loss Nutrition deficit Osteoporosis Pressure ulcers Sleep problems Thyroid disease Visual impairment

Most common elderly disease conditions Coronary heart disease Stroke Cancer Pneumonia Flu Falls (some resulting in head injury, fragility fractures, trauma)

Changes that the carer must be aware of in the care and management of the elderly Slowed reaction time Thinner skin, which can lead to breakdowns and wounds that don't heal quickly A weakened immune system, which can make fighting off viruses, bacteria and diseases difficult Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration

Aims of care for residents in Care Organisations Main objectives to maintain the highest degree of quality of life and wellbeing without subjecting residents to unnecessary and inappropriate medical and therapeutic interventions to provide sufficient support and opportunity to enable residents to manage their own disease condition (e.g. diabetes) where this a feasible and worthwhile option

Barriers to effective health management care Lack of sufficient training to acquire simple competencies Lack of structured provision of educational opportunities for nursing staff combined with lack of continuing professional education. A part consequence is a high turnover of the workforce High ratios of unqualified staff who may have little experience of elderly care and who may have negative attitudes to care of older people who are institutionalised Lack of available resources in terms of staff time, catering services, and equipment

Lack of clear boundaries of both medical and nursing responsibilities which may be exacerbated by poor communication channels Lack of regular medical review that might identify at an early stage an impending metabolic decompensation (deterioration), infection, or other co-morbid illness and prevent hospital admission Lack of clearly laid out procedures and policies in disease management

Key messages Lack of clarity within care settings in defining appropriate competencies in health management for different health and social care professionals. High level of co-morbidities and communication difficulties in service users Underestimation of the effect of existing co-morbidities in worsening clinical outcomes for service users; this could be exacerbated by lack of appropriate training for care staff.

Lack of understanding and recognition of frailty among elderly service users Restrictive professional boundaries which prevent secondary healthcare professionals from having specific input into PVI care organisations Lack of national standards of diabetes care within Social Care Organisations. As a result of many of these barriers to care, common management difficulties arise.

Key interventions Training Clearly laid out policies Regular monitoring Regular review Daily team meetings Informed handovers