Nursing Care for Older Adults with Complex Needs

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Consumer-directed care (CDC) is followed in Australia. It is regarded as an important
means of facilitating patient's autonomy along with selection of the choice of delivery of the
healthcare and the social services (Australian Government Department of Health, 2019). The
following essay is based on the case study of Martin CHEN, a 78-year old man. He is a
Chinese by birth and follows Buddhist religion. He moved to Australia with his family and
till now is residing there. After the death of his wife he stays with her daughter Chua and her
family. Lately he is expressing erratic behaviour along with loss of memory. He was admitted
to hospital for colonoscopy and also had previous reported cases of ischemic heart disease,
diabetes, hypertension and hypercholesterolemia. The essay will initiate with complex care
needs of Martin followed by discussing his three main priorities of need. This will be
followed by multidisciplinary team members who will help to reduce the unwanted chances
of hospital admission. At the end the essay will discuss the role of registered nurse followed
by potential barrier in therapy implementation, the main resources for restorative care at
home and potential medications for comprehensive care. The essay will mainly focus on how
effective care at home improves the health-related quality of life of the older adults and at the
same time reduces the chance of unwanted hospital admission.
Complex and chronic needs
According to the Australian Institute of Health and Welfare [AIHW] (2019), choric
diseases are defined as long lasting disease condition that cast persistent effect on health-
related quality of life of the individual. The chronic diseases hamper the economic and social
life of the affected individual and thereby hampering comprehensive health and well-being of
the patient. Under Australian context it can be said that rate of chronic diseases are
increasing. The eight chronic diseases that are popular in Australian demography include

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cancer, asthma, back pain, arthritis, chronic obstructive pulmonary disease, diabetes,
cardiovascular disease and mental health complications (AIHW, 2019). When two or more
chronic diseases co-exists then the overall burden of the disease increases and thus generating
the complex care needs.
The analysis of the case study highlighted that Martin is suffering from diabetes. This
is evident from high HbAc1 level (before six months). He was taking metformin (artificial
insulin) 1000 mg per day for managing high blood glucose level. Moreover he was admitted
to hospital for colonoscopy along with high blood pressure and blood glucose level. Martin
has past medical history of trans ischemic attack during 2018 and detected with type 2
diabetes mellitus (T2DM) 6 months ago. Thus Martin is suffering from chronic health
condition like diabetes and cardiovascular disease. The analysis of the case study of Martin
Chen who is 78 years old provides indication that he must be suffering from the initial stages
of dementia (mental problem) as evident from his erratic behaviours. According to Kaup et
al. (2016) the older adults who are above 65-years of age are prone towards getting affected
with neuro-degenerative disorder like dementia. The case study reveals the Martin is facing
difficulty in remembering English terms and phrases during communication, he also facing
difficulties in remembering the names of persons and daily household objects. Moreover, he
also forgets to attend the stove while it is open leading to charring of food or keep placing
garden fork in freezer. Ismail et al. (2015) stated that partial loss of memory or fragmented
cases of memory loss is the initial signs of dementia onset. Martin also hallucinates as he
cries at night and feels that he is back in this native state Hong-Kong or tells her grand-
daughter that some-one has poisoned the garden soil. Kaup et al. (2016) reported that
hallucinations along with mild behavioural impairment are associated co-morbidities of
dementia. Thus presence of diabetes, cardiovascular complications along with mental health
needs (dementia) make Martin’s clinical priority aligned with complex care needs.

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Three priorities of care
Medication Management
Medication management is an important priority of care for Martin as he is suffering
from several mental health complications (Lau & Adewumi, 2019). He was diagnosed with
Trans ischemic heart attack during 2018. He also has hypercholesterolemia and hypertension
and was detected with T2DM with high HbA1c level 7% 6 month ago. He also takes
medication for the management of cholesterol (Lipitor), diabetes (Metformin) and
hypertension/heart failure (Cardedilol). The quasi experimental study conducted by Pellegrin
et al. (2017) effective medication management among the older adults who are over 65 years
of age help to reduce the chances of unwanted hospitalization and thereby helping to decrease
the overall healthcare costs. Tinetti et al. (2016) reported that the older adults who have
cardio-vascular problems, intake of medication under stringent time-interval and in proper
dosage are important in order to avoid the chances of the cardio-vascular stroke. However,
the case study reveals that though Martin was under the hypertension medication, his last
reported cases of hospitalization showed high blood pressure level. This might be due to
improper medication management. Martin’s present exacerbation of initial signs of dementia
(memory) might be responsible for skipping of medication. Thus, effective management of
the medication will help to promote the overall concept of healthy ageing and at the same
time. Martin recent discharge from hospital also indicated impending signs of the gastro-
intestinal problems as he under-went for colonoscopy, which detected ulcer in his L-great.
Thus, his list of medications will further increase. In the hospital, three code black
emergencies were called in order to save the healthcare professional from personal or
physical thereat. Thus, it can be said that Martin is agitated and medication management will
encompass management neurological complications. Proper management of cardiovascular
problems, neurological problems along with management of cholesterol will help Martin to