Case studies with older adult mental health

In the case study of Mrs. Rudyard, who has been diagnosed with several chronic illnesses, there exist several health risks which include; poor medication adherence, isolation and cognitive deterioration, complications of diabetes, hypertension among others. The discussion explores the patients diagnoses, risk factors and complications. The care of the older adults ought to be aligned in such a way as to ensure an interdisplinary team is involved with effective referral systems to ensure enhanced care quality. Key words: Health promotion, Diabetes, hypertension, dyslipidemia What health promotion strategies might you recommend to Mrs. She is obese with a body mass index of 30. 8 with a neck circumference of 17 cm. Mrs. Rudyard ought to adhere to a healthy diet comprising of high-fiber foods such as vegetables, whole grain and fruits, healthy fats such as ; low fat dairy products, nuts and avocados and protein sources such as healthy fish for example, sardines, tuna at least twice a week.

This should be accompanied by an exercise regime of at least 150 minutes weekly of moderate to heavy exercise and resistance training for 3 days a week. Rudyard. The patient will be supported to achieve adequate sleep and minimize insomnia through education on sleep hygiene such as getting enough daylight , avoiding intake of caffeine alcohol and having her dinner early before bedtime(Miner & Kryger, 2017). She will be educated on maintaining her sleep environment comfortable to enhance her sleep. Maintaining a social network is a health intervention that ensures that the elderly have sustained functioning (Golinowska, Groot, Baji & Pavlova, 2016). Therefore connecting her to Peel region seniors like Brampton Seniors Citizen club will help her The third strategy for health promotion will aim at enhancing Mrs.

Rudyard also should be followed up on immunization for the recommended 1 dose of Tdap, then Td booster every 10 years and shingles. Exercise education is also essential as well as diet to minimize her risk for cardiovascular disease; as a preventive therapy aspirin prophylaxis can be introduced to mitigate her risks for cardiovascular disease (US Preventive Services Task Force [USPSTF]). Her dietary intake poses an increased risk for developing the cardiac disease more so with the underlying existence of hypertension and obesity. Another essential primary intervention is to have Mrs. Rudyard's immunizations updated; it is recommended for older adults to have their influenza vaccine updated annually (USPSTF). She should be educated on high-fiber foods such as vegetables, whole grain and fruits, healthy fats such as ; low fat dairy products, nuts and avocados and protein sources such as healthy fish for example, sardines, tuna at least twice a week.

Socialization: Social functioning is essential to ensure effective functioning and reduce the risk of depression. In Mrs. Rudyard's care, social integration into the community is an essential intervention to prevent the risk of developing depression and cognitive dysfunction as well as minimize risks for dementia as loneliness is a risk factor for accelerating cognitive decline(Donovan et al. Depression screening: Mrs. Psychotherapy as an intervention is essential to build the patients capacity to cope with the challenges of caring for her husband as well as being able to manage her illnesses. Through psychotherapy such as group-based cognitive-based therapy, Mrs. Rudyard will e able to share her challenges with others and develop the best approaches to coping. Psychotherapy also minimizes additional medication use hence reducing the pill burden and risks of side effects associated with antidepressants (Kok & Reynolds, 2017).

Secondary management for her chronic illness should involve support and follow up on dietary adherence such as on low salt diet to manage her blood pressure, adherence to balanced diets comprising of low fat dairy products, nuts and avocados and protein sources such as healthy fish for example, sardines, tuna at least twice a week for the management of diabetes and hyperlipidemia. Exercise education is also an important intervention which will include encouraging her to participate in more exercise such as regular morning and evening walks to enable her to remain active and manage her weight. Exercises such as strength exercises at least 150 minutes a week are also essential in maintaining balance and range of motion as well as reducing chronic pain in arthritis.

Living alone is a risk factor for medication non-adherence hence another intervention will be to educate her on medications and their scheduling. Developing a medication schedule and reminders for her will ensure that she remembers all her medication plans and schedule reducing risk of non-adherence. Self-care education and health education on her illnesses, their prognosis, and risk of complications are also imperative in the care for the patient (Mendonça & Martins, 2017). Differentials for the diagnosis include dysthymia, obstructive sleep apnea, and dementia. Dysthymia is associated with low mood for over 2 years, although Mrs. Rudyard, presents with the low mood the symptoms do not indicate low mood hence dysthymia is ruled out. There are no specific symptoms of dementia presenting for the patient and although she reports sleep disturbances they are not associated with any obstruction in her breathing or interference on the respiratory system.

What tests will you order today, if any? Provide rationale The tests to order today will include glycated hemoglobin tests (HbA1c). The discontinuation of Pantoprazole is because the drug is associated with the occurrence of headaches and increases the risk of bone fracture. I will also consider replacement of Aleve in the patient as the Nonsteroidal inflammatory drugs are associated with increased risk for stomach ulcers. What resources are available to Mrs. Rudyard in your area? Provide a shortlist with an URL if available Available resources for Mrs. Rudyard include medical journals pages on the effective approaches in managing diabetes and hypertension The Advocacy Centre for the Elderly is a community based legal clinic for low income senior citizens. ca/patientservices/seniors/Documents/Seniors%20Res%20%20Directory%20revision%20August%202013.

pdf https://www. getsmarteraboutmoney. ca/resources/seniors-resources/ https://www. peelregion. peelregion. ca/ltc/programs/respite-care. htm http://www. williamoslerhs. ca/patients-and-families/programs-services/seniors'-care PART 2 The approach to a patient presenting with symptoms described in Mrs. This is due to poor management of hypertension, dyslipidemia, and diabetes that could have resulted in damaging of the hearts structure and potentiation cardiovascular accident. ( Chief concerns can be for stroke/ PE due to aterial fibrillation) mentioned above included as vascular dementia Diagnosis The diagnoses from the EKG is that of arterial fibrillation. The EKG indicates irregular sinus rhythm with irregular P-P, R-R intervals. The occurrence of the irregularity is due to damage in the heart causing chaotic electrical signaling from the upper heart chambers and hence increased and irregular heart rate.

The arterial fibrillation causes the pooling of blood in upper heart chambers and formation of clots, the clot is dislodged to the brain resulting in blockage of supply to areas of the brain resulting in a stroke (Bowler, 2015). On discharge, she will be discharged with a medication and diet schedule and charts and a home visit plan will be agreed upon with her caregiver. The home visits will be following ups to assess her adherence to medication as well as monitor her recovery progress and reintegration into the community. Follow up visit to the clinic will also be scheduled every month to monitor progress and laboratory testing to monitor the safety level of warfarin use. PART 3 Differential diagnosis The differential diagnosis for the patient includes iron deficiency anemia due to gastrointestinal bleeding or inadequate iron intake and unexplained iron deficiency anemia of the elderly.

The patient has a history of GERD and long-term use of nonsteroidal analgesics which increase the risk of gastrointestinal bleeding. Other medication changes will be to reduce the dosage for warfarin from 5mg to 4 mg daily with more regular monitoring of the INR (Snipelisky & Kusumoto, 2013). I will also withdraw her medication from Metoprolol 50mg BID which is associated with higher risks for gastrointestinal bleeding (Reilev et al. I will prescribe an angiotensin-converting enzyme inhibitor for her management of hypertension to replace Metoprolol. Will you order any labs or imaging? Provide rationale I will order a laboratory test for hemoglobin 1 Ac to monitor the blood glucose levels which will be essential in deciding on the management of her diabetes. I will also order for stool tests for monitoring any occult bleeding, endoscopy for upper gastrointestinal bleeding and colonoscopy to assess lower gastrointestinal bleeding.

1136/jnnp. 136e Donovan, N. , Wu, Q. , Rentz, D. , Sperling, R. , Baji, P. , & Pavlova, M. Health promotion targeting older people.  BMC Health Services Research, 16(S5). doi: 10.  Archives of Internal Medicine, 165(10), 1095. doi: 10. 1001/archinte. 1095 Hollander, P. , Sugimoto, D.  JAMA, 317(20), 2114. doi: 10. 1001/jama. 5706 Marques, P. , Morai, T. , & Martins, M. Independence in basic self-care in elderly acute medical patients: a retrospective cohort study.  European Journal of Public Health, 27(suppl_3). doi: 10. 1093/eurpub/ckx189. , Olesen, M. , Thomsen Ernst, M. , & Rishøj, R. et al. Use of beta-blockers and risk of serious upper gastrointestinal bleeding: a population-based case-control study. , Iranparvar-Alamdari, M. , & Aminisani, N. Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran.  World Journal of Diabetes, 8(7), 358. doi: 10. Commentary: Diagnostic Validity and Clinical Utility of HbA1c Tests for Type 2 Diabetes Mellitus.