Life Stages

Prenatal Development

 

Prenatal development

pregnancy

infants (0-1)

• communication can be difficult
• crying
• separation anxiety

baby positioning should sleep on back, but also have 'tummy time'

Important aspects of infant health and health care

• well-baby visits
• child immunizations
• infants and sleep
• injury prevention

toddlers (1-3)

• squirmy
• unreliable history: say no a lot
• fear can start to be a problem

 

 

Toilet Training

In North America, 25% of children are toilet trained by 2 years, and 98% by 3 years

Over 90% of children gain bowel control before bladder control.

 

Signs of Readiness

Children are increasingly ready to toilet train as they become:

• ambulate independently
• are stable on potty
• desire to be independent or please
• communicate sufficiently (2-step commands)
• can stay dry for several hours (a large bladder)

preschool (3-5)

• some anxiety

school-aged children (5-12)

preventable injury is the leading cause of death (40%) in children 1-14

20% of our children suffer with mental health problems

26% of children are overweight or obese - tripled in 2 decades

1/6 children live in poverty

30% of children enter grade 1 with learning or behavioural difficulties

adolescents

 

It can be difficult to separate the adolescent from her or his parents.

Parents can be quite resistant.

Helpful hints:

to say it's usual practice.

to say we can do a switch, ie parents only after.

 

when speaking with the adolescent, let them know up front about confidentiality.

adults

seniors

• seniors and community
• health concerns affecting seniors
• seniors and transportation

 

Most health care expenditures are in the last six months (graph from CIHI: prov-territorial health expenditures by age group)

Populations are aging; baby boomers

parl.gc.ca

Some of the biggest cost drivers are new drugs and new interventions.

We have many harmful drugs and interventions, and frail elderly are at substantially increased risk. Dangerous interventions will lead to increased costs (Rockwood).

We need to

 

 

Forest and trees

Need to identify problem list, but then also summarize the overall state - the big picture.

KR: We are taught to think about illness, one at a time. This is very bad. dlp: this is a good indicator of our ability in med school to intergation.

We need to really see a shift towards CGA mentality. It's in our communication

 

Care plan: feasible, sustainable? WHose goal is it?

It is key to ensure that those who cannot be healed are still respected.

• It is no ones job to do this; it is everyones job.

Not everyone is frail, but many people are.

 

We need to be able to see a shift in our philosophy that

 

 

Atypical Disease Presentation

While younger people usually get better in hospitals, older people can get better, get worse, or get better superficially but worse functionally. We call this deconditioning, or loss of muscle mass and strength.

 

Need to make the diagnosis.

 

Frailty and delerium, and dementia are all very common and impact

Delirium, falls, immobility, incontinence, functional decline, breakdown of social supports

As people age, the atypical become typical

<50% of older patients present with non-traditional sx

 

idea: get students (ie from English) to go interview seniors in retirement homes etc and write their stories...

 

People develop about 3%/year of increased disability.

 

strokes can occur.

 

Depression is underrerpoted because there is a stigma of aging, symptoms can be masked by co-morbid illness, and there is a cohort effect for depression.

 

physical signs and symptoms, as in younger folks

psychological symptoms: acute confusion, mood s & s, delerium, psychotic symptoms

social s and s: withdrawal

functional : falls immobility, urinary incontinence, inability to perform ADLs

 

Why the atypical presentation?

Decreased reserve in a particular body system; the 'weakest link theory' suggests the least functioning system will go first' ie musculoskeletal -> falls;

 

 

Seniors and Community

 

 

 

 

Health Concerns Affecting Seniors

• falls

Musculoskeletal system

As the population ages, the prevalence of disability rises

There is some debate between aging (programmed/cumulative problems) and degeneration (excessive rate, extent, or setting).

Aging leads to decreased collagen, excessive cross-linking, decreased hyaluronic acid, and dystrophic calcification. Stiffness results.

Earles lengthen and the nose broaden

Muscles have a reduced number of Type 2A fibres and size (Type 2B). There is a greater effect on lower extremities and superficial fibres. There can be patchy degeneration of myofibrils. SR can proliferate and dilate, and tehre isa shift toward anaerobic metabolism.

The function of individual fibres is maintained, but there is fallout of the motor unit and muscle fibre. This leads to reduction of performance and Vo2 max.

This decrease in stength and power begines to decline after age 50

Tendons

fraying and fibrillation occurs, and dystrophic calcification (hydroxyapetite) can decrease strength, leading to risk of rupture

bone shinkage lowers height 1.2 cm over 20 years

loss of height comes from decrease in intervertebral disc space.

get kyphosis, increased arm/height ratio

 

Gibbus deformity

 

 

 

Seniors and Transportation

Transportation is fundamental to social involvement and is related to the built environment and people's abilities.

 

Senior and Driving

Some seniors with medical conditions should have their driving assessed. Medications can cause trouble as well.

 

When discussing changes to people's driving, tell them 'driving is a priviledge, not a right...' and say 'its not due to health, not age'

 

End of Life

 

Remember Me - slide show of a woman's end of life.

 

Bereavement is the response to the death or loss of a loved one. It is normal. Occasional hallicinations (feeling the person's presence, hearing their voice, etc) are normal.

Bereavement can bcome abnormal based on:

• duration (two months is suggested as a cutoff, though it is individual)
• severity suggesting depression: marked functional decline, suicidial ideation, psychotic features,
• global guilt (more than feeling bad around circumstances of the loss
• intense worthlessness
• marked psychomotor etardation

Not being prepared for a death is a risk factor for emergence of depression.

 

Follow-up is important.

Referral to a grief group.

Engagement of social supports.

 

Not everyone does well after bereavement.

At two months, almost half of people have subsyndromal or full depressive syndrome.

(Zisook et al, 1994).