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Adults Seeking Vision Rehabilitation Services

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Adults Seeking Vision Rehabilitation Services

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Why Is Osteoarthritis An Age-Related Disease?


The main purpose of the assignment is to review the case scenario of Mr Dinh Nguyen, an 83 year old widower with history of health issues and ongoing symptoms of grief and isolation and identify the main nursing care issues for the client. It engages in critical reflection using the Levett Jones clinical reasoning cycle to identify three nursing care priorities for the patient and then discuss on the most important care priority. The Miller’s functional consequence theory will be utilized to identify the important care priorities for the patient.
Consider the patient:
Mr. Dinh Nguyen is an 83 year old patient who lives alone in his two story home. Earlier his wife used to live before she died twelve months ago. Mr. Dinh has migrated from Vietnam in 1976 and the current health issue for him is that he is suffering from ongoing grief and isolation. As he does not have any children, isolation and grief has significantly affected healthcare of the client. Currently he is also facing issues in doing daily activities like cooking, showering and dressing because of blurred vision, electric shock type feeling during head and neck movement and numbness in his face. He is also experiencing urinary incontinence.
Collect cues/information:
The cause behind Mr. Dinh’s current health condition can also be understood from review of past medical history too. Six years ago, Mr. Dinh was diagnosed with multiple sclerosis. Four years ago he was diagnosed with osteoarthritis. In addition, issues related to feelings of isolation and grief has emerged after the death of his wife. As he does not have any children and do not want to involve them in his daily life, getting no social support is also a cause behind depressive symptom for the client. Currently he is also on three medications and one is for exacerbation of symptoms.
Process information:
The above symptoms and current challenges for Mr. Dinh can be understood from the application of Miller’s functional consequences theory. He has been experiencing challenges in daily life activities because of age related changes and presence of many risk factors too. He suffered from osteoarthritis in the past. This might have occurred because of aging related changes. Osteoarthritis is highly recognized as an age related disease because it is the most common disorder in eldelrly people. Anderson and Loeser (2010) explains that age is the greatest risk factor for the development of osteoarthritis because of age related changes in the function of cells and tissues of the body. The cells and tissues lose the capability to maintain homeostasis due to aging particularly during stress. The same issue is not so serious in young adults because young age adults can compensate for stress declines compared to older adults. Hence, it can be said that decline in basic cellular mechanism involved in homeostasis with aging is the reason for joint tissue loss and osteoarthritis for Mr. Dinh. Urinary incontinence was also a problem for Mr. Dinh and this also limits social activity of people. It also contributes to multiple sclerosis (Nerli & Hiremath, 2017).
Another negative functional aspect that has been identified for Mr. Dinh based on the review of health issues is the issue of depressive symptom in patient. His symptom of grief and increasing isolation is an indication of depression. Depression is a mental health condition associated with symptom of low mood, feelings of sadness and loss of interest in activities. Lack of family member’s support and living alone has been recognized as the risk factor of grief and isolation in patient. Another risk factor for depression might include presence of many physical illness. Mr. Dinh suffered from many health issues in the past such as multiple sclerosis, blurred vision, mobility issues and gait impairment. There is a complex relationship between physical illness, disability and depression. Evidence suggests that physical illness in old age contribute to permanent disabilities and this negative has an impact on mobility and self care needs of patients (Fässberg et al., 2016). Hence, they start developing feelings of depression. It is crucial that Mr. Dinh received proper attention at this age and his dignity be respected too so that his depressive symptoms can alleviate.
Social isolation and loneliness is also predictive of depressive symptom in elderly people. Lack of children, death of Mr. Dinh’s wife and lack of any other form of support is indicative of loneliness and reduces connection with families. This might have significantly affected emotional wellbeing for the client and eventually contributed to depression. It has an adverse impact on functional status of elderly people too as they become dependent on activities of daily living (Shankar et al., 2017). Courtin and Knapp (2017) suggest that large number of people are living alone now and this might be a risk factor of being isolated, physically and mentally ill. Dinh is experiencing challenges in daily task like cooking, showering and dressing also because of age associated physical changes such as blurred vision, electric shock feeling and numbness in the face. Kempen et al. (2012) explains that low vision has an impact on activities of daily living and feelings of anxiety in older adults. The health related quality of life of older adults with vision problem is low because of its impact on functioning and symptoms of depression. Therefore, rehabilitative service is needed to improve the quality of care.
Identify problem or issues:
Based on the review and interpretation of all information available related to Mr. Dinh, three major health issues has been identified for Mr. Dinh. The first health issue is the presence of symptom of depression indicated by feelings of grief and isolation. Many risk factors such as diagnosis of physical illness, loneliness and lack of social support has been recognized as a risk factor of grief in patient. Controlling his symptom is important as this may worsen his mental state and may lead to suicide ideation and self harm tendency too.
The second health issue identified for Mr. Dinh is dependence on activities of daily living because of blurred vision, numbness in the face and electric shock. This might have occurred because of risk factors such as aging and diagnosis of osteoarthritis and multiple sclerosis in patient. Hence, controlling signs of shock is important as this may help to address mobility issue and also increase participation in social activities. Urinary incontinence is also identified as a health issue for Mr. Dinh as the symptom is worsening and he is feeling uncertain about his future because of multiple comorbidities. Treating these three factors will be important to promote functional progress in patient.
Top priority of care:
Among the three health care priorities, feelings of grief and isolation has been identified as the top priority for patient because of multiple illness and age related disability in patient. The issue of numbness and worsening of urinary incontinence has made Mr. Dinh anxious and he is suffering from grief because of inability to manage his health issues and not being able to receive appropriate family support too. Hence, to reduce symptom of grief and isolation, the main goal of care is to reduce feelings of grief and anxiety in patient, improve his ability to engage in self care activities and prevent depression from returning. It is also planned to mitigate feelings of social isolation in patient to reduce the risk of suicide. Landeiro et al. (2017) argues that reducing social isolation and loneliness is important as it is highly prevalence in elderly population and negative influence physical and mental health too.
Take action:
To achieve the above mentioned goals based on the care priority of addressing depression and isolation in patient, it is planned to implement the nursing intervention of personal counselling so that feelings of grief and low self esteem can be addressed. Personal counselling can also help to interpret mental thought process and reason behind grief in patient and provide ideal environment for promotion of health (Aakhus et al., 2015). To address feelings of isolation in patient because of impaired social interaction, it is planned to engage client in social activities that reduce feelings of social isolation and distracts him from negative thoughts. He can also be referred to self help group who can provide right support to cope with physical illness as well as depression. As his self care activities have been affected too, assistance will be provided during mobility (Liu, Gou & Zuo, 2016). The client can also be referred to clinician to address signs of electric shock and numbness affecting gait.
Evaluate outcomes:
In response to the above intervention, it is expected that Mr. Din would be able to manage his  illness and positively cope with stress in life. Mr. Din would feel happy and pleasant by taking part in group activities and getting support in self care activities will reduce feelings of isolation. By engaging in patient centred care and respecting client’s diversity, the patient will be able to realize his self worth and dignity too. He will also be able to manage his illness well by getting the right referral for management of health.
The process of reflecting on health issues and identifying care priorities for Mr. Dinh has helped me to understand the impact of aging related changes and social factors on health and well being of older adults. Management, I lacked knowledge about cause behind electric shock in the neck and I aim to learn more about the pathophysiology of such condition in elderly so that I can plan appropriate care for patient.
The report gave an insight into three health issues for Mr. Dinh based on interpretation of current and past health issues for the client. The Miller’s functional consequences theory helped to identify negative functional consequences for the client, the risk factor of illness and its impact on overall health of patient. As depressive symptom was found to be the main consequence of all types of illness, addressing feelings of grief and isolation was identified as the top most priority. Personalized counselling and social support were planned as important nursing intervention to address disturbed though process and decrease the risk of social isolation in patient.
Aakhus, E., Granlund, I., Oxman, A. D., & Flottorp, S. A. (2015). Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study. International journal of mental healthcare systems, 9(1), 36.
Anderson, A. S., & Loeser, R. F. (2010). Why is osteoarthritis an age-related disease?. Best practice & research Clinical rheumatology, 24(1), 15-26. doi:  10.1016/j.berh.2009.08.006
Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: a scoping review. Health & social care in the community, 25(3), 799-812.
Fässberg, M. M., Cheung, G., Canetto, S. S., Erlangsen, A., Lapierre, S., Lindner, R., … & Duberstein, P. (2016). A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging & mental health, 20(2), 166-194.
Kempen, G. I., Ballemans, J., Ranchor, A. V., van Rens, G. H., & Zijlstra, G. R. (2012). The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services. Quality of life research, 21(8), 1405-1411.  doi:  10.1007/s11136-011-0061-y
Landeiro, F., Barrows, P., Musson, E. N., Gray, A. M., & Leal, J. (2017). Reducing social isolation and loneliness in older people: a systematic review protocol. BMJ open, 7(5), e013778.
Liu, L., Gou, Z., & Zuo, J. (2016). Social support mediates loneliness and depression in elderly people. Journal of health psychology, 21(5), 750-758.
Nerli, R. B., & Hiremath, M. B. (2017). Urinary Incontinence in the Elderly. RGUHS Journal of Medical Sciences, 7(3), 90-93. DOI: 10.26463/rjms/2017/v7/i3/116933
Shankar, A., McMunn, A., Demakakos, P., Hamer, M., & Steptoe, A. (2017). Social isolation and loneliness: Prospective associations with functional status in older adults. Health psychology, 36(2), 179. Retrieved from:

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