WELCOME TO OCCUPATIONAL THERAPY CARE OF THE ELDERLY TEAM

Transcription

1 WELCOME TO OCCUPATIONAL THERAPY CARE OF THE ELDERLY TEAM

2 Occccupaatti ionaal l Theerraapyy aand Caarree off tthee Eldeerrl lyy In I tthee Neewccaassttl lee Upon Tyynee Hosspi ittaal lss NHS Foundaatti ion Trrusstt The Care of the Elderly OT team in the Newcastle Upon Tyne Hospitals NHS Foundation Trust is based at the Freeman Hospital Freeman Hospital Wards 9, 13, 14, 15 and Melville Day Hospital Ward 3 Walkergate (intermediate care unit) is moving to ward 17 Freeman Hospital in July 2011 The team also provides OT cover to ward 16, a medical ward at the Freeman Hospital The admissions to the acute elderly wards can come from various sources including A & E, Emergency Admissions, and other acute medical, orthopaedic, neurological and surgical wards in the hospital and from home The Melville day unit is based at the DSC and has an active medical and rehabilitative role and provides a multidisciplinary assessment for older patients with predominantly physical problems. Elderly patients requiring rehabilitation are often transferred to ward 9 ofr 14 Freeman or ward 3 Walkergate Hospital. The Freeman team are based in an office within the disablement services centre in the Freeman grounds. The office allows the team to make any phone calls required and write up OT notes. Normal working hours are 8-4 Monday to Friday

3 Occccupaatti ionaal l Theerraapyy Intteerrvveentti I ion Occupational Therapy intervention includes full functional assessment of each patient to ensure safe discharge from hospital following admission. The Wards all have a multidisciplinary approach to the treatment and safe discharge of patients with regular MDT meetings to discuss progress and make plans. Patient s may not be discharged home but discharged to further rehabilitation wards or to residential and nursing homes after functional assessment Patients are admitted onto the care of elderly wards via many different speciality areas. If the patient has come from a different ward it is often helpful to liaise with that speciality team to discover if any OT intervention has taken place prior to their transfer. Elderly patients often come in and out of hospital frequently; because of this previous OT notes are kept in the office so they can be referred to on readmission. Suuppeerrvvi iissi iioonn Supervision takes place on a regular basis: - Band 7 OT supervised by Head OT Band 6 OT s supervised by Band 7 OT Band 5 OT s supervised by Band 6 OT OT Assistants supervised by Band 5 OT s Teeaam Trraai iinni iinngg Takes place once a month on a Tuesday pm. All staff members and grades participate including students. Topics included are relevant to the speciality. Stuuddeennt tss Students of all levels of training are regularly supervised by all qualified OT staff with more than one year post graduate experience.

4 Waarrd loccaatti l ion 99 LLeevveel ll LLeevveel ll 66 sspeecci iaal lttyy No off beedss Daai ilyy haandovveerr MDT meeeetti ingss Reehhaabbi iil lli iit taat ti iioonn 2288 Yeess 22 weeeekkl llyy Accuut tee El llddeerrl llyy ccaarree 3300 Yeess 22 weeeekkl llyy OT ccovveerr OT 1144 LLeevveel ll 66 Orrt thhooppaaeeddi iicc Reehhaabbi iil lli iit taat ti iioonn xx weeeekkl llyy 11 weeeekkl llyy 1155 LLeevveel ll 66 Accuut tee El llddeerrl llyy ccaarree 3300 Yeess 22 weeeekkl llyy 1188 LLeevveel ll 11 Accuut tee El llddeerrl llyy ccaarree MDU DSC Daayy hhoossppi iit taal ll N/ /A nn/ /aa Waal llkkeerrggaat tee 33 Waal llkkeerrggaat tee.. Moovvi iinngg too t 1177 Innt I teerrmeeddi iiaat tee ccaarree 3300 Yeess 33 weeeekkl llyy Ass rreeqquui iirreedd 1199 Yeess 11 W eeeekkl llyy 66 OT OT 66 OT

5 Deessccrri iptti ion off Speecci iaal littyy Primary Conditions There are many conditions which result in elderly patients being admitted to hospital with but there are some primary conditions, which are more common, they are as follows: Cardiac Dysfunction Cellulitis Chest Infection Urinary Tract Infections (UTI s) Acute confusion due to infection Chronic Obstructive Pulmonary Disease (COPD) Chronic Pain Cognitive Impairment CVA/Hemiplegia Dementia Diabetes Falls Fractures Decreased mobility Oncology Osteoarthritis Parkinsons Disease Renal Impairment Rheumatoid Arthritis Sensory impairment Patients are quite often admitted with more than one of the above problems Assessment Assessments can include the following: Activity Analysis Activities of Daily Living Environment Evaluation for Adaptive Equipment Cognitive Components Psycho-Social Skills/Components Screening of Sensory Skill & Components Visual Screening Work and Productive Activities

6 Intervention The OT intervention on the care of the elderly wards can be spilt into numerous areas. Performance areas in activities of daily living Dressing Feeding/Eating Functional Communication Functional Mobility Transfers Grooming and Hygiene Object Manipulation Socialisation Work and Productive Activities Domestic ADL Safety Procedures Performance Components When completing interventions there are several performance components, which are looked at during the process. These areas are listed below. Neuromusculoskeletal Muscle tone Postural control/alignment Range of motion Reflex Strength and endurance Motor Bilateral integration Fine co-ordination/dexterity Gross co-ordination Praxis Visual Motor Control Sensory Biofeedback Perceptual processing Sensory/Processing Sensory Awareness Cognitive Integration and components Object recognition Sequencing Use of standardised assessments (MEAMS and MMSE)

7 Psychosocial Skill and Components Coping skills Role performance Time management Therapeutic Adaptations Adaptive equipment Prevention Co-ordination of daily activities Energy conservation Theoretical Models Guiding Practice There are 6 main theoretical models that guide practice on the care of the elderly wards. They are: Rehabilitation approach Client centred approach Cognitive approaches Problem solving approach Compensatory approach Educational approach

8 Reading List Elderly Care Gravell R. (1988) Communication problems in elderly people: practical approaches to management. Croom Helm Ltd: Beckenham. Chapters 4 & 5 (pgs 52-94) Squires A. (1996) Rehabilitation of older people: a handbook for the multidisciplinary team. Chapman & Hall: London. Chapters 7 & 14 Kauffman T. (1999) Geriatric rehabilitation manual. Churchill Livingstone: Edinburgh. Pgs Lord S, Sherrington C, Menz H. (2001) Falls in older people: risk factors and strategies for prevention. Cambridge University Press: UK Chapters 6 & 9 & 11 Turner A, Foster M, Johnson S. (2002) Occupational therapy and physical dysfunction: principles, skills and practice. Churchill Livingstone: Harcourt publishes. Chapter 7 Creek J. (1997) Occupational therapy and mental health. Churchill Livingston: Pearson Professional Ltd Chapter 21 (Older People) Shukla R.B & Brooks D. (1996) A guide to care of the elderly: The Stationery Office: London. Chapter 27 Early M.B (1998) Physical dysfunction practice sills for the occupational therapy assistant. Mosby: New York Chapter 17 Hagedorn R. (1999) Foundations for practice in occupational therapy. Harcourt Publishers Ltd: London. Pgs (Problem based recording systems) Hansen R. & Atchison B. (2000) Conditions in occupational therapy: effects on occupational performance. Lippincott Williams & Wilkins: Baltimore.