Common Health Problems

In previous modules, you learned about diseases in aged care and other health conditions affecting older people. The health conditions covered can be found in the following modules:  

Module 1.6 Disease Management  

• Hypertension 
• Diabetes 
• Chronic obstructive pulmonary disease (COPD) 
• Osteoarthritis 
• Cardiovascular disease 
• Chronic Kidney disease 
• Rheumatoid arthritis 
• Stroke 
• Parkinson's disease 

Module 3.1 Dementia 

Module 4.4 Assessing Risk 

• Pressure Ulcers 

You may want to revisit and review your previous learning as your knowledge of these health conditions will be built upon and expanded in this module. 

Also, take some time to do your own research on common health conditions for the older people using trustworthy sites like healthify.nz or tewhatuora.govt.nz 

Activity - Drop and Drag 

Asthma is a common respiratory condition. New Zealand has one of the highest rates of asthma in the world, affecting up to 1 in 8 adults. Individuals with asthma may experience varying degrees of severity, and understanding the triggers and effective management strategies is essential for providing optimal care. 

Watch: What is asthma? (1:45)

Watch this 2-minute animated video to learn more about asthma. 

What causes Asthma? 

Asthma is thought to be caused by a combination of genetic and environmental factors. 

Genetic factors 

Asthma and allergies are closely linked. About 70 to 80% of asthma in New Zealand is associated with allergies. Often people with asthma also have eczema (allergic skin rash) or hay fever, or have close family members who have asthma, eczema or hay fever. The tendency for these three conditions to occur together is known as atopy. If you are atopic, allergies can be a trigger for your asthma.  

Environmental factors 

Certain things in our environment thought to have a role in causing asthma include: 

• allergens 
• air pollution (such as tobacco smoke or petrol fumes) 
• workplace chemicals.   

(Asthma NZ, UK, 2021) 

Learning what triggers someone’s asthma and finding ways to avoid or reduce the effects is an important part of managing asthma.  

Common asthma triggers include: 

• house dust mites
• infections of the airways, such as colds and flu  
• pollen or mould 
• pets 
• cigarette smoke 
• weather, such as change in temperature, cold weather or humid weather 
• exercise 
• stress and high emotion 
• chemicals that irritate the airways, such as sprays, perfumes, cleaning fluids 
• some medications (read more about medications that may trigger asthma). 

Asthma symptoms in older people

There are quite a few symptoms of asthma in older people. Use your observation skills to report, record and document the warning signs of asthma. Some common symptoms of asthma in older people are:  

• Wheezing or coughing  
• Coughing with sputum  
• Shortness of breath  
• Breathing complications  
• Tightness in the chest.

A mild asthma attack can include any of the above symptoms and can last several minutes. A severe attack may include all the symptoms in the list and will last longer.    

Warning signs of asthma  

• Frequent asthma symptoms with day-to-day activities  
• Using an inhaler more often  
• Symptoms are not letting a person sleep at night.

These signs will need immediate medical treatment: 

• Breathing issue worsens  
• Inhaler doesn’t work  
• Breathing difficulties don’t allow the person to speak properly  
• Lips turning grey or blue.

How is Asthma diagnosed?  

Diagnosing asthma in older people involves a comprehensive approach, including: 

Medical History: 

• Explore respiratory symptoms and relevant history. 
• Assess for allergies or family history of asthma. 

Physical Examination: 

• Focus on the respiratory system, noting signs like wheezing. 

Lung Function Tests: 

• Utilise spirometry to measure airflow. 
• Consider Peak Expiratory Flow (PEF) measurements. 

Allergy Testing: 

• Identify specific allergens through skin or blood tests. 

Exclusion of Other Conditions: 

• Rule out conditions like COPD or heart failure. 
• Use chest X-ray or CT scan to rule out other conditions. 

Response to Treatment: 

• Monitor improvement with asthma medications. 

Why Is Asthma Difficult to Diagnose in older people?  

Asthma treatment in older people can sometimes be difficult. This is because they often have other underlying health concerns. The symptoms of those medical conditions can be similar to asthma symptoms. As a result, it becomes difficult to diagnose asthma in older people.  

The most common asthma symptom in older people is coughing with sputum. Sputum is the fluid that comes out with a cough. A doctor may interpret this symptom as a cause of other illness. For example, chronic bronchitis or heart failure can have the same symptoms.   

Doctors can recognise asthma in young adults from breathing issues after exercise, however, older people are more likely to be inactive in their older ages. As a result, it becomes difficult to recognise the symptoms. Thus, the support worker can play an important role by knowing their client's baseline health and changes in health that may be caused by asthma, including wheezing, chronic cough and breathing shortness during regular activities of daily living (ADLs). 

Treatment for Asthma  

Although asthma cannot be cured, effective management through proper medication use and self-care measures allows for well-controlled symptoms in the majority of individuals. 

The goal of asthma treatment is to maintain control over symptoms and prevent asthma attacks or sudden exacerbations, enabling individuals to lead a full and active life without disruption to daily activities. 

Treatment approaches depend on whether individuals use a budesonide/formoterol inhaler or a steroid inhaler with or without a long-acting bronchodilator. 

Flu vaccine 

People with asthma are at increased risk of complications from the flu, even if their symptoms are mild or well-controlled by medicine. Complications include pneumonia (lung infection), heart failure and worsening asthma symptoms. The flu is also associated with an increased risk of hospitalisation for people with asthma. 

Read for more information on asthma.

Now that you have learned about asthma and reviewed common health problems discussed throughout the course, take a moment to assess your knowledge by detecting the signs and symptoms of common health problems. Remember to apply your knowledge of observation skills when reading and answering the questions in the following scenarios.  

You are working as a support worker at Rivercrest Retirement Village. Your goal is to detect and identify the underlying health problem through observation and communication with your clients, after which you will record and document the changes you notice. 

Activity - Scenarios and Quizzes

Scenario 1 

Mrs. Heke has just finished her lunch in the communal dining area. As you assist her back to her room, you observe the following: 

• Excessive Thirst: Mrs. Heke requests water repeatedly, more than usual. She finishes a glass of water but still appears thirsty. 
• Frequent Urination: During the short walk back to her room, Mrs. Heke asks to use the restroom twice, which is unusual based on her typical routine. 
• Fatigue and Weakness: In her room, Mrs. Heke appears more tired than usual. She expresses feeling weak and lethargic, which is a departure from her typical level of energy. 

Observational Clues: 

You notice that Mrs. Heke's skin appears dry and warm to the touch. 

She mentions feeling tingling sensations in her feet. 

Scenario 2  

Mrs. Anderson has just completed a group exercise session in the activity room. As you assist her back to her room, you observe the following: 

• Shortness of Breath: Mrs. Anderson is noticeably more breathless than usual, even after mild physical activity like walking. 
• Persistent Cough: During the exercise session, Mrs. Anderson had a persistent cough, which she attributes to a recent cold. However, the cough seems more pronounced and prolonged than expected. 
• Fatigue and Limited Endurance: In her room, Mrs. Anderson appears fatigued and mentions feeling tired quickly, even though the exercise session was not overly strenuous. 

Observational Clues: 

You notice the use of accessory muscles (neck and shoulder muscles) while breathing. Mrs. Anderson's fingertips and lips have a bluish tint. 

Diagnostic Tests:

Mrs. Anderson's recent medical records indicate a history of smoking. Given the observed symptoms, the healthcare team has scheduled pulmonary function tests (PFTs) to analyse and assess respiratory function and oxygen levels. 

Scenario 3

Mr. Sione has just completed a physiotherapy session in the designated exercise area. As you assist him back to his room, you observe the following: 

Dialogue: 

You: "Mr. Sione, how did the physiotherapy session go today?" 

Mr. Sione: "It was alright, but my back and thighs are hurting more than usual." 

Observations: 

• Pain and Discomfort: Mr. Sione winces in pain and expresses discomfort while you assist him back to his room, even though the physiotherapy session was not overly strenuous. 
• Limited Mobility: In his room, Mr. Sione struggles to change positions and appears hesitant to put weight on certain areas of his body. 
• Redness and Swelling: While helping Mr. Sione change into comfortable clothing, you notice areas of redness and swelling on his buttocks and the back of his thighs. 

Observational Clues: 

You observe that Mr. Sione is often sitting for extended periods during physiotherapy sessions, and he uses a wheelchair for mobility. 

Diagnostic Tests:

Mr. Sione's care plan indicates a history of limited mobility, and given the observed symptoms, the healthcare team has scheduled a thorough assessment, including skin inspections and pressure mapping, to identify and address potential pressure sores. 

As support workers caring for older people, it's crucial to understand not only the signs and symptoms of common health problems but also the potential risks these conditions pose to the well-being of our clients. Here, we will explore the risks associated with some prevalent health issues in the older population. 

Let's learn about the risk factors for each health problem. Select each label below to learn more.

Scenario

Patient Information: 

• Name: Leena Patel 
• Age: 80 
• Existing Health Conditions: 
  • Chronic Obstructive Pulmonary Disease (COPD) 
  • Asthma (uses an inhaler) 
  • Stage 2 Pressure Ulcer on Left Heel 
  • No history of smoking 

Initial Assessment: Mrs. Patel reports a persistent dry cough, increased difficulty breathing, and a reduced appetite. During your initial assessment, you observe the following: 

• Mrs. Patel appears fatigued and breathless, especially during activities. 
• She is coughing frequently, producing minimal sputum. 
• Wheezing is audible upon auscultation of her lungs. 
• The pressure ulcer on her left heel shows signs of redness and increased warmth. 

Evaluation 

As Mrs Patel's support worker, evaluate her health and consider the following questions: 

• Detect and list three potential health problems that Mrs. Patel may be experiencing based on the provided information. 
• Evaluate and rank the risks these problems pose to Mrs. Patel in order of clinical importance.  
• Recommend future prevention methods for addressing these health problems, providing a justification for each recommendation. 

Now compare your answers with the ones below by selecting the label or (+) sign:

Health Problems for Mrs. Patel

1. Exacerbation of COPD and Asthma: The persistent dry cough, increased difficulty breathing, and audible wheezing suggest a potential exacerbation of her respiratory conditions. 
2. Malnutrition and Reduced Appetite: Mrs. Patel's reduced appetite may contribute to malnutrition, impacting her overall health and recovery.  
3. Pressure Ulcer Progression: Signs of redness and increased warmth indicate potential progression of the pressure ulcer on her left heel. 

Ranking and Justification

1. Exacerbation of COPD and Asthma: Given the immediate threat to respiratory function, exacerbation of COPD and Asthma is the highest clinical risk requiring prompt intervention.  
2. Pressure Ulcer Progression: While concerning, the pressure ulcer progression is ranked second, necessitating measures to prevent further deterioration.  
3. Malnutrition and Reduced Appetite: Although important, addressing malnutrition and reduced appetite is ranked third, considering the more acute respiratory concerns. 

Recommendations for Future Prevention

1. Respiratory Management: Adjust inhaler usage, consider additional bronchodilators, and closely monitor respiratory status to address the exacerbation of COPD and Asthma. 
2. Pressure Ulcer Prevention: Implement pressure-relieving devices, conduct regular turning schedules, and maintain proper wound care to prevent further progression of the pressure ulcer.  
3. Nutritional Support: Collaborate with a dietitian to develop a personalised nutrition plan, encourage small, frequent meals, and monitor Mrs. Patel's dietary intake to address malnutrition and appetite concerns. 

Let’s explore common treatment methods for prevalent health problems in aged care residents. As support workers, your role is vital in assisting residents with their treatments while collaborating with healthcare professionals. Understanding basic treatment approaches enhances your ability to provide effective care. The focus will be on chronic kidney disease (CKD), Pressure Ulcers, Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Asthma, and Cardiovascular Disease. 

Chronic Kidney Disease (CKD)

Treatment Overview: Medication management to control blood pressure, dietary modifications (e.g., reduced sodium intake), and monitoring fluid balance. It's important to note that the specific treatment plan varies depending on the stage of CKD and individual patient needs. 

Activity: Watch the video by Kidney Health New Zealand about treatment options for end-stage kidney disease. List the three options available to people in New Zealand.

Pressure Ulcers (Bedsores)

Treatment Overview: Regular repositioning, wound care, and pressure-relieving devices to alleviate pressure on vulnerable areas. 

Activity: Investigate the benefits of pressure-relieving mattresses in preventing and managing pressure ulcers. Compare different types available in the market. 

Diabetes

Treatment Overview: Insulin administration, oral medications, blood glucose monitoring, and lifestyle modifications such as diet and exercise. 

Activity: Identify specific strategies in your workplace to support residents with diabetes in adhering to their medication regimens. 

Chronic Obstructive Pulmonary Disease (COPD)

Treatment Overview: Inhaler use for bronchodilation, breathing exercises, and lifestyle adjustments (e.g., smoking cessation). 

Activity: Research the different types of inhalers used in COPD treatment. Provide a brief summary of each type and its purpose. 

Asthma

Treatment Overview: Inhaler use, identifying and avoiding triggers, and emergency response planning. 

Activity: Investigate common asthma triggers in a residential care setting. Develop a list of preventive measures to minimise these triggers. 

Cardiovascular Disease

Treatment Overview: Medication adherence, lifestyle changes (e.g., diet, exercise), and blood pressure monitoring. 

Activity: Watch this video and note the treatment Ian has for his COPD.

Activity - Forum

Choose one of the identified health problems and delve deeper into its treatment methods. Utilise reputable online sources, such as medical websites or government health resources, to gather information.

Share any specific recommendations or tips on the treatment methods forum thread that could be applied in a residential care setting.

This activity aims to enhance your understanding of treatment approaches for a specific health concern, fostering better care provision for aged residents.