Managing specific conditions of

older people at home

Professor Diana Lee
Professor of Nursing
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Common health problems of older adults

at home
Examples
Insomnia and sleep disturbances
Dependence
Risk of fall
Psychosocial problems: depression,
isolation
Under nutrition
Adherence to medication
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Nutritional assessment and care for

older people at home

Central Educational Unit (2006)

Causes of under nutrition in older adults

Sensory losses- loss of taste and smell affect
appetite
Functional problems e.g. feeding problem;
dentures, loss of teeth
Disease conditions such as COPD, heart disease
SOB
Conditions/ diseases (cancer , pneumonia,
pressure sore) that increase the nutritional needs
but older adult is unable to meet the need
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Causes of under nutrition in older adults

Cognitive and behavoural problems such as
dementia
Social problem- living alone or poverty
Common nutrient deficiencies in older people
Vitamin B, C
Protein
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Nutritional Assessment
Purposes
To identify nutritional practices
To identify nutritional risks
To provide information in the development of
health care plan to manage altered nutrition
status
To evaluate the effectiveness of nutritional
programs or interventions
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Nutritional Assessment
Components
Health History
Physical Examination
anthropometric assessment
Biochemical Examination
Other assessments

The Health History

Height / Weight / Appetite
Body height: ________
Body weight: _________
Weight Fluctuations: None
Gain
Loss (>5 Kg in last 3 months)
Appetite:
Normal Increased Decreased Decreased taste
Nausea Vomiting (>3 days)*
Stomatitis
Minimal PO intake (>5 days)*
Diet
Meals/Snacks (#/day): __________________
Special Diet/Supplement: Yes (please specify: __________________)
No
Previous Dietary Instruction Yes No
Compliance Yes No
Typical Daily Diet:
Breakfast: ____________________________________________________________
Lunch: ______________________________________________________________
Dinner: ______________________________________________________________
Snacks: _____________________________________________________________
Fluid Intake: (8-oz glasses/day) Restricted 0-5 Glasses
5-10 Glasses
>10 Glasses
Food Allergies: Yes (please specify: ___________________)
No
Food Dislikes: Yes (please specify: ___________________)
No

Anthropometric Assessment
To evaluate the clients physical growth,
development, and nutritional status
Measure height and weight
Body Mass Index (BMI) evaluation
Measure Waist-to-Hip ratio
Measure midarm circumference (MAC)
Measure triceps skinfold

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Anthropometric Assessment
Body mass Index (BMI)
BMI = weight in kilograms / height in meters squared
(Kg/M)

Normal
Overweight
Obese

The New Asia-Pacific Regional

Obesity Guidelines on BMI
(2000)

The WHO Guidelines on BMI

(1997 Guidelines)

18.5 - 22.9

18.5 - 24.9

23 - 24.9

25 - 29.9

> 25

> 30

Source: Asia-Pacific Regional Obesity Guidelines, WHO

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Anthropometric Assessment
Waist-to-hip ratio
Waist-to-hip ratio = waist circumference / hip
circumference
Normal findings:
Female < 0.8
Male < 1.0

e.g.
Waist 68cm (27inch)
Hip 91cm (35.8 inch)
Waist to hip ratio
(68/91) = 0.74

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Anthropometric Assessment
Midarm Circumference

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Skinfold Caliper

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Anthropometric Assessment
Triceps Skinfold
To estimate body fat stores

Standard References for TSF (Norms may be 10% lower for Asian Populations
Adult TSF (mm)
90% of Standard
60% Standard
Standard reference Moderately Malnourished Severely Malnourished
Men

12.5

11.3

7.5

Women

16.5

14.9

9.9

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Biochemical Examination and

Other Assessments

Serum albumin
Cholesterol
Haemoglobin
Serum transferrin: Fe transport protein
Blood glucose
Other assessment
e.g. oral condition, skin condition, medication,
home environment, relevant psychosocial
assessments
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Nursing management of nutritional

problem

Identify the underlying causes

Identify food preference
Promote happy eating atmosphere and environment
Suggest to have supplement added between meals
Record of Intake with calorie count are useful
indicators
Refer to home meal service for home bound patients
Refer to dentist for dental problems
Consult dietitian if necessary
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Medication management in older adults

Specific considerations
Polypharmacy: multiple prescribed
medications
Increased sensitivity to the effects of
medications increased possibility of adverse
drug reactions
Impaired renal and liver functions
Decreased excretion
Changes in drug response with age

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Medication management in older adults

Problems of vision, hearing, memory and
cognitive function decline
Therefore
More drug interaction and unwanted or
adverse reactions e.g. dizziness, confusion,
decreased mobility
Non-adherence: intentional or unintentional
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Vulnerable older adults

Cognitively impaired
Less educated
Living alone
Taking many drugs
Those with visual disturbances

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Promoting medication adherence

in older adults
Active & positive partnership: older adults and
their caregivers
More time to explain
Provide adequate information related to name of
drug, drug reaction and what should be reported
Ensure the information is well understood
Encourage the older client to prepare a written list
of all medication (with time, reason, dosage,
frequency, side effect)- memory aids
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Promoting medication adherence

in older adults
Common problems: knowing which drug to
take, what time to take and remember whether
a drug has been taken
Tool to help: self monitoring check off chart
Color coding system to quickly identify their
medication
Daily & weekly container small medication
holders with a different compartment for each
day of the week.
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Special considerations for the

visually impaired
Evaluate clients capacity (visual acuity, visual field)
to follow the medication instruction.
Position medications in the clients visual field.
Keep adequate light in the drug preparation area.
Teach to use optical device such as magnifying glass
if needed.
Improve signage: e.g. large font size, color coding ,
colored caps

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Special considerations for the

visually impaired
Instruct the proper methods of drug
administration such as eye drop, ear drop.
Listen to clients concerns such as side effects
of dizziness, consider any possibility of drugdrug reaction.
Remind client to discard outdated medicine.
Observe home environment and suggest
improvement
Refer to eye specialist for poor vision if any.

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Patient and family education on

medication management at home
Inform for any allergy or keep a record of allergy
or symptoms experienced if not severe.
Ensure understanding of all medications
especially new medications
Use a system for keeping track record of drugs
supposed to take and what drugs have taken
everyday.
If a dose is missed, take it ASAP. If it is almost
time for the next dose, skip the missed dose. Do
not take double doses at one time .
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Patient and family education on

medication management at home
keep drug in air-tight containers and store
them properly
Dont stop taking a drug without checking
with physician even if feeling better
Dont mix drugs with alcohol
Check expiry dates and discard leftover drugs
Know the number for further contact for
questions concerning the medications
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References

Hong Kong Social Welfare Department. Statistical report of services for the elders. 2011
[cited 2011 December 07]. Available from http://www.swd.gov.hk/doc/res-stat/2010fig.pdf
Chui, E. Long term care policy in Hong Kong: challenges and future directions. Home
Health care services quarterly. 2011; 20:119-132.
Sau Po centre on aging and department of social work & social administration. Consultancy
study on community care services for the elderly. The University of Hong Kong.2011.
Low, L.F. , Yap, M., & Brodaty ,H. A systematic review of different models of home and
community care services for older persons. BMC Health Services Research 2011, 11:93
http://www.biomedcentral.com/1472-6963/11/93
Allender, J.A. & Spradley, B.W. (2005). Community Health Nursing: Promoting and
Protecting the Publics Health (6thEd.) Philadelphia: Lippincott Williams & Wilkins.
Hunt, R. (2005). Introduction to community-based nursing. (3rd ed.). Philadelphia: Lippincott
Miller, C. A. (2009). Nursing for wellness in older adults (5th Ed.). Philadephia: Lippincoot
Roach, S. (2001). Introductory Gerontological Nursing . (Eds) Philadephia: Lippincott.
Stanhope, M. & Lancaster, J. (2008). Community and public health nursing (7th ed.). St.
Louis, MO: Mosby.
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