types of incontinence

stress incontinence: urine leaks when increased abdominal pressure
urge incontinence: occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine. (http://www.nlm.nih.gov)
overflow incontinence (benign prostatic hyperplasia)
functional incontinence: cannot reach the toilet on time due to functional or cognitive defectmixed incontinence (stress + urge)

assessment of incontinence

onset of problem
physical examination
history
urinalysis, uroflowmetry and bladder residual urine
frequency of micturition
number of pads used in day and night
fluid intake
patient's response to the problem
bowel assessment

prevalence of incontinence

women is twice as common as men
because of shorter urethra

advanced directives

formal means of expressing refusal of some form of medical treatment in future should incapacity prevail, and are means by which individuals express their wishes about how they would like to be treated if they become mentally incapacitated

ethical issues in gerontological setting

do not resuscitate order
decision making for demented patient
withholding / withdrawing life prolonging medical treatment
advanced directives / health care decision
elder abuse

ethical theories and decision making

ethical theories frequently appears in daily life
ethics helps people understand the routine morality and strengthen moral judgement in face of moral dilemmas
what should I do or not?
people are in dilemma as they do not understand their ethical preferences in decision making

Possible causes in domestic settings (elder abuse)

Social and value changes
caregiver stress
caregiver was abused/victim
family conflict/relationship
substance abuse by caregiver
low education level
poor social network support
poor economic condition
lack of space

types of elder abuse

physical
psychological/emotional
sexual
financial
neglect
abandonment

Kubler-Ross Model

denial
anger
bargaining
depression
acceptance

bereavement support

counselling and support to families who are facing death of their loved ones;
provided by hospitals/community e.g. Jessie and Thomas Tam centre

palliative care

an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

conditions that could cause pain

cancer
depression
diabetes
enlarged prostate
heart disease
hypertension
arthritis
osteoporosis
pulmonary conditions
stroke

pain rating scales

verbal descriptor scale
numerical rating scale
Wong-Bake FACES scale
Abbey pain scale

inhibition of pain

gentle rubbing of skin near painful area may relieve pain

pain assessment

provoking factors, causes, history
quality: how the pain feel
region/radiation: site or does it radiate elsewhere
severity: how severe or intense?
temporal: change during the day? present all the time, come and go?
treatment: what has been tried to help? what's its effect?

types of pain

nociceptive pain: caused by damage of tissues
neuropathic pain: altered stimuli usually caused by nerve damage

effects of chronic pain on cognition

forgetfulness
minor accidents
difficulty in finishing tasks
attention difficulties

elements of physical fitness

aerobic exercise
body structure
body composition
balance
flexibility
muscle strength

three aspects of health promotion

positive health education (media, professionals)
prevention (regular exercise, diet)
health protection (screening, assessment)

community-based gerontological care in HK

community geriatric assessment team
psycho-geriatric team
community nursing service
community psychiatric nursing service
enhanced home and community care service
integrated care model
integrated discharge service program
nurse-clinics in general out-patient clinics
public-private partnership program