Assignment

Introduction

This assignment will provide a patient overview, acute presenting issue, family and social history, potential stereotypes, and comorbidities for a patient above the age of 65 years old. This profile will serve to show how people aged 65 years and older constitute a unique demographic that should be understood in their specific clinical contexts.

Patient Overview

The patient, Jane Smith (name changed for confidentiality), is 66 years old. The patient is a retired female accountant living alone in Sydney, Australia. The patient’s family is of African-American and Hispanic descent, and the patient was brought up by an uncle after her mother died from a workplace related accident at the age of 32, and her father died of heart failure at the age of 37. The patient’s sister died of a myocardial infarction at the age of 45. The patient has 2 sons (aged 32 and 27) and 1 daughter (aged 23) who are healthy, and has 4 grandchildren. There is a known family history of hypertension.

The patient was a frequent user of alcohol and tobacco from 2005-2012. The patient is widowed, and leads a sedentary lifestyle with minimal exercise. The patient denies other coronary heart disease risk factors such as diabetes or postmenopausal symptoms. Furthermore, the patient’s BMI was at 31 kg/square meter upon admission, which classifies the patient as obese.

The patient’s confidentiality has been maintained through the secure storage of this report and associated personal data, in compliance with Australian patient confidentiality regulations.

Current Situation

The patient’s acute presenting issue was the presence of acute intermittent midsternal chest pain. The patient was well up till 9pm of the day of her admission, when she noted the onset of a ‘sharp pain under her left breast’ while feeding her cat. At 11pm, the pain returned with higher intensity, and she was evacuated to the hospital by a friend.

The patient was transferred to the intensive care unit upon arrival at Greenwood General Hospital. Upon admission, the patient was generally alert, conscious and active, and was diagnosed as having a left-sided myocardial infarction at the present time. The patient appeared to be in a heightened state of anxiety over her condition, but was alert and active.

The patient’s age presents contributing risk factors for the acute presenting issue. The age-related risk factor for the presenting condition includes the social isolation faced by the patient living alone, which increased the patient’s regular stress levels and delayed the patient’s ability to quickly seek medical attention upon encountering the acute presenting issue, as well as the risk factor related to falls, which prevented the patient from pursuing an active lifestyle. These are established age-related risk factors supported by evidence from Arthur (2006), who found correlations between isolation, a lack of social support and heart disease (Arthur, 2006). Furthermore, the patient’s high blood pressure and smoking were likely to have increased the risk of heart disease.

The patient could potentially be stereotyped based on her gender or her mixed minority ethnic heritage, which could potentially be the basis for several harmful stereotypes on the patient’s risk factors and clinical issues (Puddifoot, 2019). For example, there could be implicit bias against the patient due to her minority ethnicity, which may lead some healthcare providers to feel that she likely did not take care of her health properly and missed her health checkups (Puddifoot, 2019).

Health History

The patient exhibited two comorbidities that will be evaluated in this section, which are hypertension and obesity. As discussed by Lawson et al (2018), in a study of 10,575 heart failure patients, the leading cardiovascular comorbidities can have a significant impact in the rapid deterioration of patient condition (Lawson et al, 2018). Furthermore, Ebond et al (2014) observed that obesity is estimated to cause 14% of heart failure cases in women, by introducing hemodynamic and myocardial changes that lead to cardiac dysfunction, or due to the lipid accumulation in the heart which leads to direct cardiac lipotoxicity (Ebond et al, 2014). All of these heart failure mechanisms could have been induced by the comorbidity of obesity. Finally, obesity could have led to higher blood pressure, which led to stress on the cardiac system of the patient.

Secondly, the patient’s long-term history of hypertension, as observed in a study by Messerli et al (2017), is a significant comorbidity that could have led to a pressure overload and diastolic dysfunction, which are direct causes of heart failure. Hypertension may have thickened the blood vessel walls of the patient, which would have increased the patient’s risk of a myocardial infarction. Messerli et al (2017) cite multivariate studies that showed that hypertension had a high population-attributable risk for heart failure, comprising 39% of cases in men and 59% in women (Messerli et al, 2017).

The patient’s comorbidities negatively impact the patient’s current physical functional status, as the patient’s history of obesity and hypertension placed the patient at higher risk of heart failure. Furthermore, the patient’s social isolation likely increased the patient’s stress levels, and prevented the patient from seeking immediate medical care on a functional level when the acute presenting issue arose. As Dadarlat-Pop et al (2020) discussed, in their study of overweight and obese patients above 65 years old, elderly heart failure patients have clear presence of comorbidities in the form of obesity and hypertension, with symptoms such as atrial fibrillation, ventricular ejection fraction and acute heart failure (Dadarlat-Pop et al, 2020).

Conclusion

The above patient profile report presents a summary of a patient’s history, symptoms and conditions in the context of her life for a patient above the age of 65. It is important for healthcare providers to continue to use such reports and consider the patient’s history and comorbidities, as well as potential stereotypes, in determining treatment for the acute presenting issue.

References

Arthur, H. M. (2006). Depression, isolation, social support, and cardiovascular disease in older adults. Journal of Cardiovascular Nursing, 21(5), S2-S7. https://journals.lww.com/jcnjournal/Abstract/2006/09001/Depression,_Isolation,_Social_Support,_and.2.aspx

Bozkurt, B., Aguilar, D., Deswal, A., Dunbar, S. B., Francis, G. S., Horwich, T., & Rosendorff, C. (2016). Contributory risk and management of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure: a scientific statement from the American Heart Association. Circulation, 134(23), e535-e578. https://doi.org/10.1161/CIR.0000000000000450

Dădârlat-Pop, A., Sitar-Tăut, A., Zdrenghea, D., Caloian, B., Tomoaia, R., Pop, D., & Buzoianu, A. (2020). Profile of Obesity and Comorbidities in Elderly Patients with Heart Failure. Clinical Interventions in Aging, 15, 547. https://doi.org/10.2147/CIA.S248158

Ebong, I. A., Goff Jr, D. C., Rodriguez, C. J., Chen, H., & Bertoni, A. G. (2014). Mechanisms of heart failure in obesity. Obesity research & clinical practice, 8(6), e540-e548. https://doi.org/10.1016/j.orcp.2013.12.005

Janssen, D. J., Spruit, M. A., Uszko-Lencer, N. H., Schols, J. M., & Wouters, E. F. (2011). Symptoms, comorbidities, and health care in advanced chronic obstructive pulmonary disease or chronic heart failure. Journal of palliative medicine, 14(6), 735-743. https://doi.org/10.1089/jpm.2010.0479

Lawson, C. A., Solis-Trapala, I., Dahlstrom, U., Mamas, M., Jaarsma, T., Kadam, U. T., & Stromberg, A. (2018). Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry. PLoS medicine, 15(3), e1002540. https://doi.org/10.1371/journal.pmed.1002540

Messerli, F. H., Rimoldi, S. F., & Bangalore, S. (2017). The transition from hypertension to heart failure: contemporary update. JACC: Heart Failure, 5(8), 543-551. https://doi.org/10.1016/j.jchf.2017.04.012

Oikonomou, E., Chrysohoou, C., & Tousoulis, D. (2019). Heart failure a cluster of comorbidities or a unique entity?. International journal of cardiology, 277, 196-197. https://doi.org/10.1016/j.ijcard.2018.08.040

Puddifoot, K. (2019). Stereotyping Patients. Journal of Social Philosophy, 50(1), 69. https://doi.org/10.1111/josp.12269

Roche, S. L., & Silversides, C. K. (2013). Hypertension, obesity, and coronary artery disease in the survivors of congenital heart disease. Canadian Journal of Cardiology, 29(7), 841-848. https://doi.org/10.1016/j.cjca.2013.03.021