Insomnia in geriatric patients.

discuss the following: The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused. What information would be most critical for you to collect in the first visit? What is the primary goal for the treatment of this patient? Identify potential obstacles for change. Which educational approach would the PMHNP provide to overcome these obstacles? How would you teach the patient about the Beers list and Halcion? Discuss a medication in detail that could be safely substituted to treat insomnia in geriatric patients.

Sample Solution

The patient's medical history: This would include information about the patient's current medications, as well as any past medical problems.
The patient's current symptoms: This would include information about the patient's falls, confusion, and any other symptoms that the patient is experiencing.
The patient's functional status: This would include information about the patient's ability to perform activities of daily living, such as bathing, dressing, and ambulating.

Full Answer Section

The patient's social history: This would include information about the patient's living situation, as well as any social supports that the patient has.

The primary goal for the treatment of this patient would be to:

Reduce the risk of falls: This would involve addressing the patient's confusion, as well as any other factors that may be contributing to the falls.
Improve the patient's functional status: This would involve helping the patient to regain their independence in activities of daily living.
Improve the patient's quality of life: This would involve addressing the patient's anxiety and insomnia, as well as any other symptoms that the patient is experiencing.

In addition to collecting the above information, it would also be important to perform a physical examination of the patient. This would include a neurological examination, as well as an assessment of the patient's gait and balance. Based on the information that is collected, the healthcare provider would then be able to develop a treatment plan for the patient. The treatment plan may include medication changes, physical therapy, or other interventions. It is important to note that the treatment plan for this patient would need to be individualized. The specific interventions that are used will depend on the patient's individual needs and circumstances. Here are some additional questions that could be asked during the first visit:

How often do you have falls?
What were you doing when you fell last time?
Have you had any other injuries as a result of falling?
Have you noticed any changes in your balance or coordination?
Have you had any problems with memory or thinking?
How are you managing your anxiety and insomnia?
Are you taking any other medications?
Do you have any social supports?

The answers to these questions will help the healthcare provider to assess the patient's risk of falls and to develop a treatment plan.

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