Assessment Resources

The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty.

The vast majority of wound care is undertaken by community nurses (Dhoonmoon, 2023), with £941 million attributed to venous leg ulcer care and a further £836 million spent on unspecified leg ulcer management (Guest et al, 2017). If signs and symptoms can be 
recognised and a diagnosis made, a plan of care can be drawn up and treatment implemented quickly and efficiently to reduce costs escalating further. More important though, the patient’s condition will improve quickly and deterioration in quality of life can be avoided. Nursing staff are currently encouraging patients to take a more active role in their own care, guiding them in how to look after their own long-term conditions, which can promote long lasting healing and independence.

For many nurses working in primary care, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to- 
day living, most community nurses will have some experience of supporting people living with COPD. Increasingly, though, community nurses are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.

The purpose of this article is to present a scenario of a typical patient at risk of developing pressure damage and demonstrate how to complete the assessment and implement a prevention plan using the aSSKINg framework (Healthcare Improvement Scotland, 2020).  By following these recommendations, healthcare professionals can demonstrate good preventative care, reduce the risk of patients developing pressure damage, and protect their organisation against any future litigation claims (Downie, 2014).

The population is ageing and so we are seeing an increase in the prevalence and incidence of age-related conditions, such as frailty and dementia. These two conditions can often go ‘hand in hand’, making it important to ensure appropriate recognition, assessment and then management of each when experienced together. This paper uses a case study approach to illustrate and discuss the issues as relating to community nurse practice.

Palliative care of the elderly patient who wishes to die at home is an integral part of the role of community nurses. Historically, it has been found that this area is at risk of mismanagement, with poor symptom control, a breakdown in home care services and
lack of support for carers; aspects which can lead to admission to hospice or hospital. As such, this article examines the essential role of the community nurse in both practical  ways of assessment, planning and reviewing care of the patient and the family; as well
as psychological ways of supporting, guiding and listening. The article uses a case study to illustrate an example of the process of planning palliative care in the community, while acknowledging that each situation is individual to each patient, resulting in a variety of challenges. It can be seen that the community nurse is the mainstay in the whole process of palliative care of the elderly patient; providing a bespoke package of care in collaboration with the wider multidisciplinary team and thus enabling the patient to
remain at home in their final days.

A chronic cough is often a symptom of respiratory illness, but it can be brought about by many factors, i.e. smoking, being female, abdominal obesity, low income, environmental factors, allergies, medication and increased age (Colak et al, 2017). Unfortunately, a frequent side-effect of chronic coughing is urinary incontinence (UI) — mainly stress
urinary incontinence (SUI). Although quite prevalent within this cohort of individuals, there seems to be little professional knowledge with regards to interventions to prevent or treat UI. This article looks at the causes of chronic coughing and how it impacts on UI. It also
identifies how professionals can recognise at-risk patients and start treatment options.

The UK has a population of approximately 11 million adults, 18.6% aged 65 and over (Centre for Ageing Better, 2022). Indeed, the demographic profile of the population of England and Wales and primary care records indicate that one in five people are over the age
of 65 in England (Office for National Statistics [ONS], 2018; Robards, 2020). The condition of frailty is more prevalent in the older person, and estimates provided by various studies suggest that 3% of people over the age of 65 in England have the condition (Clegg et al, 2016; Sinclair et al, 2021). Community nurse caseloads are representative of the ageing population of the UK and frailty has been recognised as a clinical condition of the older person (Leary and Bushe, 2022). Early detection of frailty by experienced nurse practitioners can assist in developing a management strategy for the patient in order to inhibit progression of the condition (Ruiz et al, 2020).

Moisture-associated skin damage (MASD) is a term used to describe skin damage that is caused by prolonged exposure to moisture, such as incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis and peristomal moisture-associated dermatitis. MASD is a hugely prevalent issue in hospitals and long-term care facilities (Voegeli, 2019). Studies have shown that skin tone bias exists in the diagnosis and treatment of MASD, the impact of which this paper discusses as well as how to prevent such bias while assessing and diagnosing MASD.

Use of the revised National Early Warning Score (NEWS) 2, a tool
used to measure acute deterioration in hospital, is mandatory in acute
NHS hospitals and ambulance services. Community staff who wish
to escalate acutely unwell people to ambulance or acute services need
to be able to use NEWS. This article outlines the uses and limitations
of NEWS and how it can aid identification and escalation of people
who are acutely unwell in community settings, including those with
suspected sepsis.