Age-friendly Primary Health Care Centres Toolkit - World Health ...

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AGE-FRIENDLY PRIMARY HEALTH CARE CENTRES TOOLKITII.4 Core competencies of geriatric clinical assessment and key clinical managementapproachesClinical backgroundOlder people often have multiple complex health and social conditions and may alsopresent with vague complaints such as dizziness. These intertwining symptoms aredifficult to diagnose and treat in the limited time available at most primary care settings.Many of these conditions are chronic and must be screened, early detected andmanaged to prevent avoidable complications and disability such as amputation fromdiabetes.It is not possible to include all geriatric assessment and treatment approaches in thistoolkit. The focus therefore, is on assessment and key management strategies for thefour geriatric giants: memory loss, urinary incontinence, depression and falls/immobility.In addition, the diagnosis and key management of hypertension and diabetes – the twomajor chronic diseases which account for a high portion of illness and disability – are alsoincluded.General ObjectivesThis part aims to sensitize and train PHC workers to the approach and use of thenecessary tools to deal with the above-mentioned four geriatric giants and two majorchronic diseases.Who should use the tools?Some PHC settings are staffed with doctors and nurses, while some only have nurses orcommunity health workers. Each tool is marked with a recommendation for the lowestlevel staff to use the tool. A characteristics table is provided for each tool, that specifiesthe more adapted staff to use the tool ("by whom?"). Some staff will require trainingbefore being competent in use of the tools.Contents:II.4.1 Overall examinationII.4.1Clinical assessment and key management approaches for the four geriatric giantsGeriatric Giant 1: Memory LossGeriatric Giant 2: Urinary IncontinenceGeriatric Giant 3: DepressionGeriatric Giant 4: Falls/ImmobilityII.4.2 Clinical assessment and key management approaches for the two major chronicdiseasesManagement of hypertensionManagement of diabetes36
AGE-FRIENDLY PRIMARY HEALTH CARE CENTRES TOOLKITBelow are the critical core competencies for PHC providers working witholder people. This list can be used as a guide or checklist for identifyingstaff training needs.Communication – refer to tool on communication with older people1. Demonstrate knowledge skills and behaviour necessary tocommunicate effectively with older persons.2. Encourage participation in decisions.3. Assess barriers to seniors’ understanding of information.4. Provide health protection, health promotion and disease preventioninformation.5. Include family member and/or caregivers in teaching/learningactivities.Knowledge1. Demonstrate a knowledge and understanding of age and genderrelated changes and how they impact care.2. Demonstrate an awareness of the sensory changes associated withageing.3. Demonstrate the knowledge of atypical presentations common inold age.Assessment of health status1. Be able to assess the relationship between acute illness and knownchronic illness in older persons.2. Assess health/illness by conducting a complete history.3. Perform a comprehensive physical exam considering the changesassociated with ageing.4. Perform a comprehensive functional assessment including mentalstatus, social support and nutrition.5. Assess the task and stressors of the care giving system of the olderperson.Diagnosis and treatment1. Recognize the commonly occurring conditions associated withageing.2. Implement screening using age-appropriate instruments.3. Plan appropriate interventions based on the assessments.4. Demonstrate an understanding of age appropriate drug use forseniors including knowledge of compliance issues.5. Plan therapeutic intervention to restore and or maintain optimal levelof function.6. Coordinate care with other available health and social services.37
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Ageing and Life Course (ALC)Family
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