Ageing: Complex Care

Question 1

What are the 6 categories of elder abuse?

Answer 1

1. Sexual abuse
2. Psychological abuse
3. Racial/cultural abuse
4. Neglect
5. Financial abuse
6. Physical abuse

Question 2

List the 4 categories of risk factors for elder abuse and 1 example of each

Answer 2

1. Factors relating to the abused person
   - cognitive impairment; shared living; functional dependency; low income
2. Factors relating to the perpetrator
   - psychiatric illness; drug/alcohol dependency; caregiver burden/stress
3. Relationship between perpetrator and abused
   - family disharmony; conflicting relationships
4. Environmental factors
   - low social support; shared living

Question 3

As an individual or as a team what is your first duty in situations where abuse may be taking place?

Answer 3

Report to the hospital safeguarding team after discussing with your senior (consultant)

Question 4

What are the 4 main factors implicated in pressure ulcers?

Answer 4

1. Friction
2. Interface pressure
3. Shear
4. Moisture

Question 5

What are the 6 steps leading to tissue ischemia due to a pressure ulcer?

Answer 5

• *Sustained high pressure**
  1. Decrease in capillary flow
  2. Ischemia capillary thrombosis, occlusion of lymphatic vessels
  3. Increased capillary permeability
  4. Fluid escapes into extravascular space
  5. Oedema
  6. Cell + tissue death

Question 6

How are pressure ulcers classified?

Answer 6

Grade 1 = non-blancheable erythema of intact skin

Grade 2 = partial-thickness skin loss; ulcer presents as blister

Grade 3 = full-thickness skin loss involving damage/ischemia to subcutaneous tissue without going through underlying fascia

Grade 4 = extensive destruction to muscle, bone with/without full-thickness skin loss

Question 7

What are 9 risk factors for pressure ulcers?

Answer 7

1. Acute illness
2. Age
3. Level of consciousness
4. Limited mobility/immobility
5. Sensory impairment
6. Severe chronic/terminal illness
7. Vascular disease
8. Malnutrition/dehydration
9. History of pressure damage

Question 8

The acronym SSKIN is used to help you remember how to prevent pressure ulcers. As a junior doctor you will have a key role in this by encouraging early mobilisation, ensuring adequate nutrition and hydration and helping to look fro and manage incontinence.

What does SSKIN stand for?

Answer 8

S-support surface
S-skin inspection
K-keep moving
I-incontinence
N-nutrition

Question 9

What are the 3 types of care homes that exist in the UK?

Answer 9

1. Care home without nursing (residential home)
2. Care home with nursing
3. Specialist care home for dementia