Comprehensive Aged Care Assessment: Services, Systems, and Drugs

This report presents an aged care assessment, focusing on the case of Mr. Alex and his wife Sarah. It identifies the need for various aged care services, including personal care, mobility assistance, and home support, and the need for interdisciplinary referrals such as dietitians, geriatricians, and nurses. The report then outlines five body systems (cardiovascular, respiratory, musculoskeletal, neurological, and psychological) for assessment, highlighting age-related changes in each. It also discusses five different assessments beyond body systems, including home safety, social support, and nutritional assessments. The report further explores age-related changes in pharmacokinetics (absorption, distribution, metabolism, and excretion) and the potential for adverse drug reactions, providing examples of medications and their complications. The report emphasizes the importance of comprehensive assessment to address the complex needs of older adults and manage their medications effectively.

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Author Name
Name of the Institute
Date

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Aged Care Assessment
Identify and discuss the Aged Care Services
Aged care provides support to the old age individuals to help them in their daily life and
other needs (Detering et al., 2019). In this scenario, Mr Alex lives with his wife Sarah and have
come to General Practitioner (GP) for their assessment. Also, Mr Alex is functionally better, but
Mrs Sarah has dementia and she is unable to do basic tasks on her own and her husband takes to
care for her.
The health care needs of individuals increase with their age. Therefore, it is necessary to
provide appropriate services to Mr Alex and Sarah to assist them in managing their life routine.
With the arrival of Mr Alex and Sarah at the clinic, it was noticed that personal care is
compromised. Therefore, support and supervision in hygiene and cleaning (bath and/or shower),
personal grooming including oral hygiene and skincare must be given to them (Jorgensen et al.,
2018).
In old age, mobility becomes a great deal for individuals. In this scenario, Sarah needs
support for mobility and Mr Alex is her caregiver, however, his limited mobility due to wound
on his leg is a hindrance to the caregiving work he does for Sarah. Therefore, services of
mobility for Sarah, as well as Mr Alex through the premises of the home and outside it, are
necessary. Furthermore, house cleaning, making beds, washing and ironing clothes, making
household purchases, preparing food adapted to the dietary needs of the person are the services
that must be provided to the couple for their effective care (Schmidt et al., 2017). Moreover, Mr
Alex is unable to effectively move and commute to the hospital, accompaniment to medical
visits, rehabilitation service, accompaniment in residences, etc. must be provided to him.
Interdisciplinary Referrals

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Based on the identification of health issues of Mr Alex, referrals are made, taking into
account the individual needs of both of the individuals. Concerning his wound, the professionals
who provide care are attentive to the reporting of possible symptoms, or situations generated by
their health issues and ageing.
The type and proportion of food an individual eats have a major impact on his/her overall
health. A dietitian can provide Mr Alex with food and nutrition information to help him improve
his health and manage his lifestyle. As the couple seems underweight, a referral must be made to
the dietitian for the proper assessment of nutritional deficiencies (Detering et al., 2019).
Allied Health Professionals are university-trained physicians who are part of the aged
people care team and generally help recover or manage chronic illness after illness or injury.
They will continuously monitor the health and care services that are provided to Mr Alex for the
provision of appropriate care.
Geriatricians specialize in the care of aged individuals. A referral can be made to the
geriatrician for advice on specific age-related health problems (Schmidt et al., 2017). It will
result in more comprehensive geriatric assessment and provision of effective care.
Considering the condition of Mr Alex and Sarah, a carer must be provided to them for
home care. The nurse will monitor and plan their care and monitor their overall health. They will
be able to talk to the nurse about their care needs and preferences and any concerns about their
health (Jorgensen et al., 2018). It will help them in adhering to the treatment regimen, assessing
their health status and changing the bandage.
Due to their increased age, they may encounter some problems that limit their exercise
and functionality. Physical therapists use manual therapy, exercise programs, and electrotherapy

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techniques to treat musculoskeletal conditions such as arthritis (Giuliante et al., 2018), which
would be helpful for Mr Alex in managing their arthritis problem.
Identifying Five Body Systems for Assessment and Age-Related Changes
The age-related changes reduce the functional reserve of the organ system and reduce the
ability of the older people to cope with stress, such as illness, hospitalization and loss of function
(Burn et al., 2018). The assessment of musculoskeletal system, neurological system,
psychological assessment, respiratory system and the cardiovascular system must be done for a
comprehensive evaluation of an older patient.
With the age, the structure of the heart gradually deteriorates, including loss of elasticity,
fibrotic changes in the heart valves, and amyloid infiltration. The most influential age-related
structural feature is the contractility of the left ventricular wall (Parker et al., 2018). Since
various changes affect the structure and function of the myocardium, the pumping capacity of the
heart decreases with age. As Mr Alex has angina and Myocardial Infarction, a cardiovascular
assessment must be done to assess the functioning of the heart.
Respiratory function becomes slow and gradually deteriorates with increasing age.
Muscle strength and grip reduces and an increase in chest wall stiffness occurs with age. There is
less response to hypoxia and hypercapnia (Parker et al., 2018). Reduction of the alveolar surface
and production of surfactant. Mr Alex is a continuous smoker which suggests the assessment of
respiratory functioning.
Age-related changes can adversely affect function. Sarcopenia is the loss of muscle mass
and strength caused by the deterioration of skeletal muscle fibres. Sarcopenia increases the risk
of falls, disabilities, and can lead to unsteady gait and the need for help (Lee et al., 2016). Weight
loss, protein deficiency, and lack of exercise will accelerate the loss of muscle mass and strength.

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The musculoskeletal assessment of the couple would greatly help in understanding their
functionality status.
The nervous system, as well as the muscles and special senses, will change with
increasing age. In general, these changes lead to a decrease in executive functions and memory,
sensory transfer and processing, motor functions (such as slowness of movement), and a
decrease in coordination, balance, and gait (Lee et al., 2016). As Mr Alex’s functional ability is
decreasing, executing neurological assessment would give awareness regarding the deteriorating
neurological functions.
Although Mr Alex is psychologically healthy, however, there is a need to conduct a
psychological assessment for age-related depression. Most of the individuals in this age go
through the psychological problems due to loneliness, decreased functionality and financial
matters (Åhlund et al., 2017). Moreover, psychological assessment of Sarah must be done to
evaluate her dementia status. The decline of memory and functions in dementia is permanent and
gradual.
Identification of Five Different Assessments (Other Than Body Systems)
The home safety assessment allows the practitioner to define characteristics that can
promote falls (e.g., inadequate lighting, slippery bathtubs, poorly attached rugs) and suggest
solutions (Lee et al., 2016). Mr Alex’s functionality has impaired and Sarah cannot take care of
herself. Therefore, it is necessary to determine the factors that can contribute to falls and
eliminate them.
Assessment of social support, in this case, is a critical element as it would shape the
services that will be provided to the patient. Physicians should obtain information about the
patient's lifestyle, in particular, where and with whom he lives (e.g., if he lives alone in an

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isolated house or in an apartment that is part of a populated building), the accessibility of his
residence (e.g., by stairs or on a hill) and the means of transport available to access to their home
(Lee et al., 2016). These factors affect the ability to get food, health care, and other important
resources.
Nutritional assessment of Mr Alex and Sarah is important as both of them are
underweight. It is necessary to evaluate if the patient can eat (e.g., chew and swallow). As Sarah
needs prompting to eat and drink, it is essential to provide the home care services with an
emphasis on nutrition. Those with visual impairment, arthritis, immobility, or tremors may find it
difficult to prepare food (Parker et al., 2018).
Most elderly patients have limited potential to become completely healthy and
independent. Therefore, one must choose the outcome that is most important to them and their
families (Åhlund et al., 2017). Patient care goals are generally positive (e.g., recovery from past
health conditions). Mr Alex has been an active individual and provides care to his wife. Being
functionally disable would have an adverse effect on his self-confidence. Therefore, goals of care
assessment for improving his functionality would greatly help him being independent again.
It was recognized that several psychosocial factors, such as worry, anxiety, discomfort,
difficulty in performing ADLs, and financial burden, must also be addressed to complete a
comprehensive assessment of the aged people (Åhlund et al., 2017). In this scenario, the most
important thing in the quality of life is maintaining good social relationships with family, friends
and neighbours; participate in social and voluntary activities and personal interests and be in
good health and functional capacity.
Age-Related Changes that Affect Pharmacokinetics

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Pharmacokinetics refers to the disposition of the drug in the body and consists of four
steps: absorption, distribution, metabolism, and excretion (Unutmaz et al., 2018). Each of them is
modified differently with the ageing process. The pharmacokinetic processes that are most
altered are distribution and elimination (metabolism and excretion).
Although the total intestinal epithelial surface, the motor function of the intestine,
splanchnic flow and acid secretion decrease with age, the absorption of most drugs that pass
through the gastrointestinal epithelium by diffusion does not decrease in the elderly (Chang et
al., 2019). With absorption being the pharmacokinetic parameter that is least affected by ageing.
The presence of concomitant drugs that could interfere with the absorption of other drugs should
also be considered. The distribution of a drug depends on the volume of distribution and the
degree of protein binding (Neves et al., 2019). Both processes change with ageing. With age,
there are changes in body composition that affect distribution.
The effect of age on metabolism is mainly due to changes occurring at the liver level,
mainly decreasing phase I enzymatic reactions. This is why those drugs that require phase I
reactions will see their biotransformation decreased, so there could be an accumulation of the
drug and/or active metabolites (Vatcharavongvan, & Puttawanchai, 2017). Renal excretion is
diminished by decreased renal blood flow, glomerular filtration and tubular reabsorption since all
these processes slow down with age.
Age-Related Adverse Drug Reactions
The special condition of the aged individuals, which alters the pharmacokinetics and
pharmacodynamics of drugs, together with the fact that they often receive unnecessary
medication, greatly increases the probability of suffering an adverse effect, which is also not
always correctly identified (Kwak et al., 2019). Adverse drug reaction is considered by anyone

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undesired effect resulting from the use of drugs at therapeutic doses. In the case of Mr Alex,
several risk factors that contribute to adverse drug reactions are grouped: poly-pathology,
polypharmacy and presence of possible dependence on activities of daily living. All of this leads
to the frequency of presenting adverse drug reactions being two to seven times higher in the
elderly than in those under 60 years of age (Kwak et al., 2019).
In Mr Alex’s case, a drug can produce an adverse drug reaction that can be interpreted as
a second disease and the clinician prescribes drugs for this adverse reaction. This situation would
put him at risk of developing adverse reactions from additional medications, related to this new
unnecessary treatment. This is what is called “prescription cascade” (Kwak et al., 2019). To
prevent prescription cascade, any new sign or symptom should always be considered as a
possible consequence of current drug treatment.
Medications and Their Potential Complications
Mr Alex takes Omeprazole for Gastro-oesophageal reflux disease (GORD). The potential
complications of Omeprazole include upper respiratory infection and headaches. Moreover, it is
also observed that Omeprazole can cause or worsen hypertension (Unutmaz et al., 2018).
Ibuprofen and Panadol are taken by Mr Alex for pain relief related to arthritis. The potential
complications of Aspirin include stomach problems, while Ibuprofen can make hypertension
worse. Also, it is indicated in a study by Gomes et al. (2020) that long-term use of NSAIDs will
likely worsen arthritis. Perindopril is used for hypertension, but it can cause symptoms of
GORD.
Reflection
I have learnt quite a lot of things from this case study. First of all, I gained much more
knowledge than I thought I would about care services for aged people, facts about increasing

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aged care requirements, and what is required to be done in the scenarios which include a
comprehensive assessment of aged patients. I also learnt to have a responsibility by doing my
part to help the individuals in need by providing effective care.
I have little experience in providing care to aged people. However, when I encounter the
individuals who need further assistance and referrals, I make sure to make an appropriate referral
and do not cause them unnecessary pain of commuting. Older people in clinics often have
several different diagnoses and consequently have several complex health needs. I also gain the
knowledge that a greater proportion of older individuals need an interdisciplinary approach to
their care to deal with complex multimorbidity, social and psychological issues.

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