[DO1]Older is currently trying to return home to

Posted on

[DO1]Older is currently trying to return home to

 DO1Older
adults negative attitudes about  wellness

 DO2ADLs
vs IADLs-Mobility/functional status

 DO3Why??

Theresa
stated early that she believed she was aging successfully. While she may have
medical issues that limit some of the activities she used to independently complete,
she has kept in mind that the way she perceives herself is the greatest tool
she has to wellness. She says that “If you can think it, then you can be it”. I
believe she is determined to age well. With the right tools and resources, she
can do the very thing she has put her mind to do: Live well.

My
concerns for her living situation is for the shower safety, stapled electrical
wires and a too low of a bed for her to get in and out easily. DO3  Without
appropriate grab bars anti-slip mats and shoes in the shower, she could fall
and not have anything to hold her. This could result in a life-threatening
situation. With electrical wires stapled to the walls, a fire can start from
damaged wires. Mrs. Theresa could either not make it out of the house in time,
harm herself while evacuating or not detect the smoke from the fire. The wires
should be replaced with new, non-frayed or damaged wires. They should be
secured to the floor or wall with electrical tape or the electrical appliances
should be wired through the walls. I recommend Theresa to continue in her
efforts in maintaining her health. I believe she should implement some weight
bearing exercises like walking and non-weight bearing exercises like swimming (Shanb &
Youssef, 2014).
I recommend Theresa limit oils and fats from her diet to lower the accumulation
of lipids in her blood vessels. Also, implement lots of green leafy vegetables,
and fortified foods. I commend her on her community and family involvement.

Theresa
is currently trying to return home to Nigeria. She is scouting out a 1 floor
flat in Nigeria. She did not want stairs so she could prevent life threatening
falls when no one is home with her. She would like to keep her independence for
as long as possible. She is looking for homes next to her oldest daughter’s so
she would be near family. Theresa’s oldest daughter is a medical doctor with a
hospital. The hospital is nearby to where both would be living. Should there be
a need for immediate hospital access, it is nearby.

  Theresa has appropriate cognitive function.
She is a quick wit and a socialite. An age-related change to her social
endeavors was a decrease in her hearing. Around age 75, Mrs. Theresa began
mishearing her morning prayers. Her daughters told her that when they would
come over, her tv would be too loud. When speaking to someone, she would not be
able to understand clearly what someone was saying so she would ask them to
repeat and speak louder the next time. Unfortunately, she had some hearing
loss. Some age-related changes related to hearing is dysfunction of the hairs
within the ear canal. These hairs promote air conduction which leads to the perception
of hearing noise (Contrera, Wallhagen, Mamo, Oh,
& Lin, 2016).
Mrs. Theresa had to get a hearing aid to be able to participate in her social
life. She stated that she was emotional due to the physical manifestations that
she was getting older even though she does not feel old therefore she does not
wear the hearing aid sometime. Also, she had some degree of vision decline.
Some age-related changes in vision are related to dysfunction of the ciliary
body, stiffening of the lens and reduced visual field. Her vision began to
decline due to cataract formation. This prevented her from going out with
friends in the evening because she could not see. Eventually she got the
removal surgery so now she just wears her glasses to read.  Despite the vision and hearing barriers, she still
socialized and partied with her friends and family.

Another
medical concern with Mrs. Theresa was her history of Bradycardia. This was a
significant issue because it caused frequent fallsDO2 .
Also, her HZD usage could have contributed to her frequent falls because of
hypotension.  This could have created
issues with getting out of bed at night to urinate or walking up and
downstairs. However, she states that besides some aches and pains from the
frequent falls, she never broke or injured anything seriously. 1 out of 5 older
adult clients who fall, develop serious injury (CDC, 2017). These injuries take
prolonged periods of time to heal. Her primary healthcare physician discovered
the bradycardia and suggested a pacemaker. A pacemaker is a device that is
surgically placed in chest of heart to fix abnormal heart rhythms. Since the
placement of the pacemaker, her falls have significantly reduced. She is still
a fall risk because of her age and functional status. However, since her
procedure, her physician does not recommend her flying or taking long extended
trips where she will not be able to ambulate frequently. She does not like that
because she is used to trips to France by way of train or taking flights back
home to Nigeria. She states that it was because of this procedure that she had
to get an escort just to fly back home.

Some
additional ADLs are Instrumental activities of daily living(IADLs) these like
grocery shopping, housekeeping, medication management, religious socialization
or telephone use. Mrs. Theresa states that since the onset of the cervical
stenosis pain, she has not frequented mass and the other places she used to go
as often. She can still use the phone and clean her house. She handles her own
medication because of the large print on the medication bottles allows her to
read clearly. She has begun to rely on her children to grocery shop and cook
for her. Some assistive and adaptive equipment that allow Mrs. Theresa to
maintain some independence are an elevated toilet seat, shower chair and
walking cane.

One
thing Mrs. Theresa buys into is the marking of supplements or vitamins. There
are a lot of theories on how supplementation of certain vitamins and
antioxidants would reduce free radicals from building up in the body. Free radical
theory states organisms age because the incur damage (Gladyshev,
2014).
These molecules have the potential to interact with normal lipids, proteins and
nucleic acids and induce aging. Many supplements and creams are marketed to
claim that they will reduce free radicals in your body. Mrs. Theresa is
resolute that the various extra supplements that she takes, helps her to
maintain her health. When the Ebola epidemic arose in the African continent,
Mrs. Theresa had heard that grapefruit extract would prevent you from
contracting the Ebola virus. She soon gave that advice to all the people she
knew who were travelling to African countries where Ebola was on the rise.

Mrs.
Theresa is trying to maintain her functional status by being independent in her
Activities of daily living(ADLs) like hygiene, grooming and ambulation. Some
barriers to her functional status is diminished hearing, sight and
musculoskeletal function. Mrs. Theresa was diagnosed with Osteopenia.  Osteopenia is bone loss. It is the forerunner
to Osteoporosis. Bones normally undergo remodeling. Remodeling entails the
removal of old bone and the replacement of new bone. In an older adult, removal
of bone happens quicker than the replacement of new bone. According to
Physiotherapy Canada (2012), It stats that women are 3 times as more likely to
be diagnosed with osteoporosis than men Also, Mrs. Theresa has cervical
stenosis. This causes bone pain. For which she takes Neurontin (Gabapentin).
Gabapentin is cautioned in older adults with impaired renal clearance because
it is excreted through the kidneys. According the Merck Manual (2016), one normal
age-related changes in the liver is the decreased ability to metabolize products.
Gabapentin not metabolized by the liver so it is excreted in its full form. This
can alter the concentration of medication within the body before it is
excreted. I asked Mrs. Theresa what she does to maintain her bone integrity.
She said she eats foods high in calcium alongside with vitamin supplementation.
This would be a positive functional consequence. Eating foods high in calcium
with additional supplementation, is compensating for the age-related changing
Mrs. Theresa is facing (Fleury & McMahon, 2013).

Recently,
she flew to Nigeria. After the flight, Mrs. Theresa stated that she felt her
feet were extremely swollen. In Nigeria, she asked a Physician for something to
relieve the swelling. So, they increased her HydrochlorothiazideDO1 
prescription. I believe this is a barrier to wellness in Mrs. Theresa. One type
of barrier as stated by Carol Miller, is the act of attributing abnormal health
symptoms to aging rather than looking for contributing factors that are
reversible and treatable. Mrs. Theresa could have been advised to request a
seat with leg room to stretch during her flight. Post the flight, Mrs. Theresa
could have been taught to elevate her feet, and doing some light exercise for a
few days after the flight to have the edema resolve on its own. Those options
would have been great non-pharm solutions instead of extra HZD. This is an
attitude that must be improved so that wellness can be increased in Mrs.
Theresa.

Mrs.
Theresa has had primary hypertension since late adulthood (60-70). Primary
hypertension has an unknown cause. It is hypothesized that is results from a
mixture of the renin-angiotensin-aldosterone-system(RAAS) overactivity and
peripheral vascular constriction. In an older adult, hypertension is further
exacerbated by the decrease in elasticity of blood vessels causing systemic constriction.
Mrs. Theresa is on a Hydrochlorothiazide regiment to control her hypertension. According
the Merck Manual (2016), one normal age-related changes in the kidney is the
decrease or sluggishness of filtration of blood. Hydrochlorothiazide in
cautioned in older adults with liver, kidneys or heart dysfunction. Mrs.
Theresa has periodic kidney function tests to monitor her kidney function.  Additionally, Mrs. Theresa states that since
she moved into her older adult community, she has lost weight from walking around
so much. However, that has reduced.

Mrs.
Theresa Osibamowo would like to claim that she is successfully aging. Though
she has some chronic pain and mobility issues, she says she is enjoying the
rest of her life. Mrs. Theresa Osibamowo is 89 years old. She currently resides
in Woolwich, England. She has lived in a variety of places like Nigeria,
England and Italy. One fun fact about Mrs. Osibamowo is that she was born in a
leap year. She claims that because of that, she is not 89 years old but much
younger. She and her husband pursued business endeavors in engineering, by buying
and building various building and structures. She has primary hypertension, osteopenia
and a pacemaker. Some of the age-related changes she is experiencing are some
hair, vision and hearing loss. Mrs. Theresa is quick witted and a socialite.
She maintains that one of the ways she stays young is because she engages in
parties with her friends and family.

Successful
aging is defined differently by various bodies of thought. It the biomedical
field, Rowe and Kahn, proposed that successful aging is founded on the lack of
disease and disability, high cognitive and physical function and active
engagement with life (Martin, et al., 2014). More recent
research claims that the previous spectrum on successful aging is too narrow.
Very few people are able to maintain a lack of disease and disability to “age
successfully”. Mrs. Theresa is one of those people.

admin
Author