Clinical Pathway For Family Wellness Promotion in Elderly: Junayyah A. Sarip Jaeron Den D. Topinio

CLINICAL PATHWAY FOR FAMILY
WELLNESS PROMOTION IN ELDERLY
JUNAYYAH A. SARIP
JAERON DEN D. TOPINIO
Post Graduate Interns
“Health or wellness
is a state of complete
physical, mental, and
social well-being, and
not merely the absence
of disease or infirmity.”
– WORLD HEALTH ORGANIZATION
2015
7.5%
NON-COMMUNICABLE
DISEASES
• In the Philippines, diabetes accounts
for 4,260 deaths for males and 7,320
for females 70 years old and above.
• The prevalence of hypertension

among Filipino elderly is 6.2%
NON-COMMUNICABLE
DISEASES
• Colorectal cancer is most frequently
diagnosed among adults aged 65 to
74 years.
• Seventy percent of deaths due to

prostate cancer occur after age 75
years.
COMMUNICABLE DISEASES
• Advanced age are more susceptible to

CAP.
• >65 years old are at greater risk of

serious complications from flu 
immune defenses become weaker
with age.
The Philippine Health Agenda
2016-2022 seeks to uphold
every Filipino’s right to health
consistent with the International
Alma ATA Declaration that
health is a fundamental human
right as well as the PAFP
mission CARES.
The general objective of this
pathway is to improve the
quality of health care of the
Filipino family through health
maintenance, promotive and
preventive care.
First Visit
HISTORY & PHYSICAL EXAMINATION
COMPREHENSIVE GERIATRIC ASSESSMENT
A multidisciplinary diagnostic and treatment
process that identifies medical, psychosocial, and
functional capabilities of older adults to develop a
coordinated plan to maximize overall health with
aging.
GERIATRIC ASSESSMENT CHECKLIST
Personal data
Highest education attainment
Occupational history
Financial resources
Health Insurance
Living arrangement
Primary caregiver
Housing
Past Medical History
History of chest pain/angina,
breathlessness on exertion and lying flat,
numbness or weakness of limbs, loss of
weight, increased thirst, polyuria, puffiness of
face, swelling of feet, passing blood in urine,
asthma
Family history
Past surgical procedures
Medication
• Polypharmacy
– Older persons are often prescribed
multiple medications by different
health care providers, putting them
at increased risk for drug-drug
interactions and adverse drug
events.
GERIATRIC ASSESSMENT
CHECKLIST
Nutrition
– inadequate micronutrient intake
– Vitamins A, C, D, and B;
calcium; iron; zinc; and other
trace minerals
– MNA-SF® can be widely used
MINI NUTRITIONAL ASSESSMENT
SHORT FORM
A. Has food intake declined over the past
three months due to loss of appetite,
digestive problems, chewing or
swallowing difficulties?
B. Involuntary weight loss during the last 3
months?
C. Mobility?
D. Has the patient suffered psychological
stress or acute disease in the past three
months?
MINI NUTRITIONAL ASSESSMENT
SHORT FORM
E. Neuropsychological problems?
F1. Body mass index (BMI)?
F2. Calf circumference (CC) in cm
Screening Score:
12-14 points: Normal nutritional status
8-11 points: At risk of malnutrition
0-7 points: Malnourished
Physical activity
– Types of exercise:
 Endurance
 Balance
 Flexibility
 Strength training
Immunization History
Review of Systems
– Vision
• ophthalmologic examination
– Hearing
• Whispered voice test at 2 feet
• Audioscope
• Hearing Handicap Inventory –
Screening (HHIE-S)
INTERNATIONAL
PROSTATE SYMPTOM
SCORE
1. Incomplete emptying
2. Frequency
3. Intermittency
4. Urgency
5. Weak Stream
6. Straining
7. Nocturia
– Speech and Language
– Balance
– Cardiac
– Pulmonary
– Gastrointestinal
– Sexual
– Neurologic and Psychiatric
Fall Assessment
– Timed Up and Go Test
Physical Examination
 Vital signs, weight, height, BMI, WH ratio, Waist
circumference, Pain
 HEENT
 Chest, Lungs
 Abdomen
 Spine, Extremities
 Neuro Exam
Functional Capacity
• Katz index activities of daily living
• Lawton’s instrumental activities of
daily living
Table. Comparison of Katz ADLs and Lawton IADLs
Activities of Daily Living Instrumental Activities of Daily
Living
Feeding Using the telephone
Continence Shopping
Transferring Preparing food
Toileting Housekeeping
Dressing Doing laundry
Bathing Using transportation
Handling medications
Handling finances
Cognition
• Mini Mental Status Examination
Mood
• Late-life depression remains underdiagnosed and
inadequately treated.
• “During the past month, have you been bothered by

feeling down, depressed, or hopeless?”
• “During the past month, have you been bothered by
little interest or pleasure in doing things?”
For women
• Age at menopause
• Use of Hormone replacement therapy
• Previous use of oral contraceptive pills
• Utilization of preventive services such
papsmear, mammography and dexa
screening

Clinical Pathway For Family Wellness Promotion in Elderly: Junayyah A. Sarip Jaeron Den D. Topinio

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CLINICAL PATHWAY FOR FAMILY

WELLNESS PROMOTION IN ELDERLY

• The prevalence of hypertension

• Seventy percent of deaths due to

• Advanced age are more susceptible to

• >65 years old are at greater risk of

• “During the past month, have you been bothered by

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