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Geriatric Patient Management Description

Geriatric Patient Management Description

An eighty years old female patient presents with complaint of anxiety, panic attacks, and insomina.  Past medical history is significant for CAD, HTN, HLD, DM and COPD.  Describe the assessment, planning, and interventions that are appropriate in this situation.  Are there any endocrine considerations?  What goals will you sent for therapy in this geriatric client?

Discussion 8: Geriatric Patient Management

An eight-year-old female patient has presented to the office with chief complaints of anxiety, panic attacks, and insomnia. The patient’s past medical history is significant for coronary artery disease, hypertension, hypersensitivity lung disease, diabetes mellitus, and chronic obstructive pulmonary disease. First, the comprehensive geriatric assessment can be applied as it is the most detailed research model used in the assessment of geriatric patients in a primary care setting. CGA is a multidisciplinary diagnosis and treatment process, which aids in the identification of medical, functional, and psychosocial limitations among frail older persons and the development of a coordinated treatment plan for the maximization of their health (Dunphy, et al., 2019). The care of the older adult patient extends past the conventional medical illness management as it necessitates an assessment of numerous issues, comprising the physical, social, cognitive, financial, environmental, spiritual, and affective factors influencing health.

The premise of CGA assessment is the methodical assessment of the frail patient by a team of experts to identify the various treatable health issues resulting in improved health outcomes. The main constituents of comprehensive geriatric assessment, which should be evaluated during the assessment process, are functional capacity, social support, cognition, fall risks, financial concerns, mood, polypharmacy, care goals, and advance healthcare preference (Pilotto, 2018).  The other components included in the evaluation are nutrition, change in weight, urinary continence, vision, dentition, hearing, spirituality, and living situation. The majority of the older adult patients suitable for CGA usually have restricted potential of returning to a wholly healthy and independent life. Thus, it is imperative to plan for choices that should be made about the health outcomes that are most important for the patient and their family. Besides, healthcare goals are different from advanced healthcare preferences, which emphasize the future state of health that is acceptable and the selection of surrogates who will make decisions, as well as preferred medical treatments. The clinician should start discussions with the patient about their preferences for treatment while still having her cognitive capacity to make decisions (Sudore & Fried, 2010). The discussion includes planning and preparations for in-the-moment, which comprises the selection of a suitable decision-maker, clarification, and articulation of the values of the patient over time.

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The possible diagnoses related to aging can include anxiety and depression. The clinician should also determine the kind or combination of disorders and other underlying conditions. Furthermore, elderly patients tend to have an inexplicably greater prevalence of metabolic and endocrine dysfunction (Owens et al., 2011). The endocrine considerations that are frequent in old age and applicable in this situation include adult hypopituitarism, adrenal insufficiency hypothyroidism, diabetes mellitus, hypogonadism, and endocrine malignancies. Untreated anxiety leads to disability, cognitive impairment, poor physical health, and low life quality. The proposed treatment includes medication, therapy, reduction of stress, coping skills, and family and social support. The medicines used in the treatment of anxiety disorders include antidepressants, beta-blockers, and anti-anxiety medications used to control the symptoms.

There are age-related physical changes that predispose the older patient to difficulties with drug therapy since the suitable drug should be selected with care taking into consideration a number of factors such as loss of baroreceptors. The Beers criteria is an important clinical tool that assists clinicians in the improvement of medication safety among older adults (Dunphy et al., 2019). The therapeutic intervention goal is to help the patient who may be experiencing difficulty with her transition of aging in managing their emotions, finding sources of meaning enjoyment and meaning, and finding a new support system. Finally, individual and family therapy will assist the patient’s family members in supporting the patient in coping with their emotions, communication problems, and other resources.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B.O. & Thomas, D.J. (2019). The art and science of Advanced Practice nursing. Philadelphia, PA: F.A. Davis Company.

Owens, D.  Kalra, S. & Sahay R. (2011). Geriatric Endocrinology. Indian Journal of Endocrinol Metabolism 15, 2, 71–72.

Pilotto, A. (2018). Comprehensive geriatric assessment. Cham: Springer.

Sudore, R. L., & Fried, T. R. (January 01, 2010). Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Annals of Internal Medicine, 153, 4, 256-61.

Welsh, T. J., Gordon, A. L., & Gladman, J. R. (January 01, 2014). Comprehensive geriatric assessment–a guide for the non-specialist. International Journal of Clinical Practice, 68, 3, 290-3.

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