Assessment and Planning of Discharge Needs in Geriatrics

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Assessment and Planning of Discharge Needs in Geriatrics
Elderly patients have unique discharge planning needs. As such, the hospital nurse and case management team may find themselves challenged to not only identify the needs of each patient, but to also address those needs when planning the patient’s discharge. In the case of Mr. Trosack, a 72-year-old widower being discharged following a total hip replacement (THR), careful assessment of his home situation needs to be completed prior to discharge to ensure his safety and continued recovery once home. Healthcare Issues

After reviewing the patient’s chart and performing interviews with the patient and his family, the case manager identifies three healthcare issues that need to be addressed on discharge. ·The patient admits he has not seen a doctor in over 10 years prior to this hospitalization. ·The patient has been diagnosed with two new health issues: hypertension and diabetes. ·He has been prescribed new medications for each new diagnosis that he will need to continue taking after discharge. ·The patient cannot identify pills he currently takes at home, stating simply that they are “vitamins” for “energy.” Importance of Healthcare Issues

Each of these issues needs to be addressed to ensure Mr. Trosack’s safety and continued recovery after discharge: The patient has not seen a doctor in over 10 years prior to this hospitalization. It is important for the case worker to find out why the patient has not seen any doctors, as it may be detrimental to his well-being. For example, did he have a bad experience with a previous provider and refuses to go back? Or, has he just not felt ill? Is his reasoning ability still sound? Or, is there some confusion? Is he in denial or facing fear that has kept him from seeing someone? If the patient is able to make sound decisions and simply has no concerns, he may do well at home. However, it may also be that he is unaware he should be seeing a physician, as “elderly patients may not report symptoms that they consider part of normal aging” (Besdine, 2009, para. 9). And, if he has had a bad experience in the past with a physician, it may have lead to a mistrust of the entire profession. If he has been refusing to see a doctor despite some concerns over the years, it could foreshadow similar situations in the future. He may not call when new problems or questions arise about his new medications. And, as evidenced by the cabinet of unused medications in the bathroom, he has a history of poor compliance, which could further impact his health. By discussing the reasons behind his lack of preventative care, the case manager will better understand the patient’s mindset and any concerns he may have. If a previous provider’s treatment or behavior has caused a mistrust of the profession, the case manager can recommend or introduce the patient to other providers, especially those that specialize in caring for geriatrics, as these providers have specialized training in caring for the elderly. If cost is a factor, the case manager can refer the patient to applicable programs such as food stamp programs, insurance and Medicare supplement policies, state-based programs, drug company assistance programs and more. If transportation is an issue, the case manager can refer to area agencies or senior citizen centers to utilize low-cost or volunteer-driven services that assist in transporting seniors. The patient has been newly diagnosed with hypertension and diabetes. New medical diagnoses can be scary for any individual, but with elderly patients, it can often bring about a new level of uncertainty and anxiety. Like all patients, they have questions about the new diagnosis and prescribed medications. However, the elderly patients of today grew up in a time when medical problems were not openly discussed. And now, society often looks at senior citizens as “lesser” citizens—a source for humor and pity in the media, weaker,...
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