Cuidados del anciano

 " Elderly Cares for Nursing"

Nursing subjet -

San Jorge University

Saragossa, Spain

CRISTINA RUIZ ESTERAS

Bibliography

This blog has been created by Cristina Ruiz mats, but the information has been consulted on many pages and books such as those given below

• HOFFMAN, Gloria. Basic Geriatric Nursing 5th Edition. Elsevier.2012.
• BURKE, Mary M./WALSH, Mary B. Enfermería Gerontológica: Cuidados Integrales del Adulto.Harcourt-Brace. Madrid 1998
• CARNEVALI,Doris L.PATARICK,Maxine.Enfermeria Geriátrica. Ed. Interamericana/Mc Graw-Hill. Nueva York/Madrid 1996
• GARCÍA Hernández, M./TORRES Egea, M.P./BALLESTEROS Pérez, E. Enfermería GeriatricaEditorial: Masson Barcelona 2003.
• GUILLÉN Llera, F. PÉREZ del Molino, J. Sindromes y cuidados en el paciente geriátrico. Ed. Elsevier. 2007.
• MILLÁN,J.C.Gerontología y Geriatría.Valoración e intervención. Ed.Panamericana. 2011.
• RODRIGUEZ, R. Práctica de la geriatría. Ed Mcgraw-Hill.2007.
• WACHTEL,T.J. ; FRETWELL, M.F. Guía práctica para la asistencia del paciente geriátrico. Ed. Elsevier.2008; 3a ed. 2008

PALIATIVE CARES

The World Health Organization’s (WHO) definition is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems (WHO, 2005).

The goal of the geriatric palliative cares is care to the chronical and fragile elderly to relieve pain and suffering, giving them the best possible quality of life.

The palliatives cares are given to people in situation where there is no cure.

Needs of the Geriatric Palliative Care Patient:

• Continuity and coordination of care that responds to episodic and long-term chronic diseases and the management of multiple chronic illnesses
• Maintaining functional independence as possible
• Decision regarding care and the risk versus benefit of treatment
• Pain and symptom control
• Home support for family caregivers
• Community resource information

Nursing have an important role in palliative cares because a nurse spend a lot of time near patients, more than the doctor and they are the indicate persons to help to patients to express their feelings and be they feel safe in their last moments

Its very important the psychological area in this kind of patients, not only the physical condition.

GERIATRIC SYNDROME: URINARY INCONTINENCE

URINARY INCONTINENCE is a unwanted leakage of urine, it has a several impact in the quality of life and leads to the shame and social isolation: it cause anxiety and depression in a big percentage of people who suffers it.

The Uninary incontienence imposes a several burden on caregivers and it is one of the mains causes for admission into a nursing home.

There are differents kinds of uninary incontinence:

1. Stress UI: defined as an involuntary loss of urine associated with activities that increase intra-abdominal pressure. 

2. Urge UI: characterized by an involuntary urine loss associated with a strong desire to void (urgency).  An individual with an overactive bladder may complain of urinary urgency, with or without UI. 

3. Mixed UI: usually defined as a combination of Stress UI and Urge UI

4. Overflow UI: an involuntary loss of urine associated with over-distention of the bladder and may be caused by an under-active detrusor muscle or outlet obstruction leading to over-distention of the bladder and overflow of urine.

5. Functional UI: caused by nongenitourinary factors, such as cognitive or physical impairments that result in an inability for the individual to be independent in voiding .

Treatment Treatment of UI in elderly:

 Medications

 Anti-incontinence rings incontinence rings

 Mi i ll I i S Minimally Invasive Surgery

 Behavioral Treatment

-          Bladder Diary

-          Pelvic Floor exercice – Kegel’s execice

-          Bladder training: frequent voluntary voiding

Nursing Care Strategies

A. General principles that apply to prevention and management of all forms of UI:

-          Identify and treat causes of transient UI

-          Develop an individualized plan of care using data obtained from the history and physical . Implement toileting programs as needed

-          Avoid medications that may contribute to UI

-          Avoid indwelling urinary catheters whenever possible to avoid risk for UTI

-          Monitor fluid intake and maintain an appropriate hydration schedule.

-          Limit dietary bladder irritants.

-           Modify the environment to facilitate continence.

-           Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments.

GERIATRIC SYMDROME: CONSTIPATION

Constipation is a common disease of older people.

 The reason why older people prone to constipation, mainly causes is follow:

there are a mainly causes to produce the constipation in elderly and it can coexist at the same time:

1. They do less activity and their phsysiological functions.

2. The suffer diseases like anemia, diabetes, depression, central nervous system diseases...all of this have a influence in the costipation

3. They take a lot of drugs. The opiate for exaple dicrease the peristaltisms

4. They could suffer a obstructive process.

ASSESSMENT TO PREVENT THE CONSTIPATION

1, schedules to develop regular bowel habits

2, Good diet: Usually the elderly should eat more food with cellulose and fruits to increase  fiber intake for stimulate and promote intestinal peristalsis.

3, a good water intake : to increase the intestinal peristalsis, and promote defecation.

4, increase the activity:

5, the mood of optimism: anxiety and other bad mood can lead to or aggravate constipation. Despiste of this, elderly people should always keep a good mood.

6, medication: In the elderly can use drugs to help defecation. Paraffin oil can be oral or enema. be noted that the elderly  should not be long-term use of drugs in order to avoid the formation of dependency so that the function of peristalsis degradation, increase constipation.

GERIATRIC SYNDROME: FALLS AND INESTABILITY

Falls are a common and serious problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions.

Most of these falls are associated with one or more identifiable risk factors ( weakness, unsteady gait, confusion and certain medications etc ), and research has shown that attention to these risk factors can significantly reduce rates of falling.

Older adults can remain independent and reduce their chances of falling.  They can:

·             Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.

·             Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.

·             Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.

·             Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways and improving the lighting in their homes.

GERIATRIC SYNDROMES. NEUROLOGIC DISEASE: Alzheimer's disease

Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life

Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older.

Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years.

SYMTOMS:

People in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses, they may: become confused and frequently forget the names of people, places, appointments and recent events xperience mood swings, feel sad or angry, or scared and frustrated by their increasing memory loss become more withdrawn, due either to a loss of confidence or to communication problems and they have difficulty carrying out everyday activities

As the disease progresses, people with Alzheimer's will need more support from those who care for them. Eventually, they will need help with all their daily activities.

While there are some common symptoms of Alzheimer's disease, it is important to remember that everyone is unique. No two people are likely to experience Alzheimer's disease in the same way.

Alzheimer's has no current cure, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer's and their caregivers.

GERIATRIC SYNDROMES: IMMOVILITY

Immobility is a common pathway by which a host of diseases and problems in the elderly produce further disability. Persons who are chronically ill, aged, or disabled are more susceptible to the adverse effects of prolonged bed rest, immobilization, and inactivity.

The effects of immobility aren’t confined to only one body system.

It could be pshyical:  Muscle wasting, Contractures, Muscle pain, Osteoporosis, Pressure sores, Hypothermia, Aspiration pneumonia, Constipation, Incontinence, Deep vein thrombosis and Anorexia ect.

Or Psychological and Social : Isolation, loss of independence, Sensory deprivation, depression, delirium and dementia

It may later cause a lot of complications.

Immobility in the elderly often cannot be prevented, but many of its adverse effects can be.

 Improvements in mobility are possible for the immobile older adults:  A small improvement in mobility can decrease the incidence and severity of complications.

Would be usefull to  develop and implement a care plan that specifically addresses immobility.

* nursing should also document range-of-motion exercises and progressive mobility activities in the medical record. They should periodically summarize the results, noting the resident's overall progress and whether the old person is using assistive devices.

* Nursing staff should teach residents little ways to get exercise even while bedridden.

* Staff at the nursing home should avoid putting a resident on bedrest: the elderly  should be on bedrest for only the shortest amount of time possible.

* If a old person is not progressing as expected, the nursing home staff should find out why

*  It's necessary Advice about  a well-balanced diet rich in proteins and minerals.

Another cares could be: postural changes, massage, good hygene…

CARE OF AGING SKIN AND MUCOUS MEMBRANES: PRESSURE ULCERS

 Pressure ulcers are a type of injury that break down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.

HOW PRESSURE ULCERS DEVELOP?

Pressure ulcers can develop when a large amount of pressure is applied to an area of skin.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients and begins to break down, leading to an ulcer forming.

WHO IS AFFECTED?

Pressure ulcers tend to affect people with health conditions that make it difficult to move, especially the bend – bound patients or  people who spend a lot of time  sitting because they have movility disorders.

Conditions that affect the flow of blood through the body, such as type 2 diabetes increase the risk.

 

WHERE IT COULD DEVELOP?

The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface:

The bed bound patients have the risk to develop it in:

·         shoulders or shoulder blades

·         elbows

·         back of head

·         rims of ears

·         knees, ankles, heels or toes

·         spine

·         tail bone

People who use the wheelchair could develop pressure ulcers in:

·         buttocks

·         the back of arms and legs

·         the back of  hip bone

WHAT IS THE TREATMENT ?

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. For the most serious cases, surgery is sometimes recommended.

.

Pressure ulcers can be unpleasant, and challenging to treat. Therefore, there are techniques to prevent pressure ulcers developing in the first place. These include:

·         regularly position changes

·         using equipment, such as specially designed mattresses and cushions, to protect vulnerable parts of the body

Unfortunately it is not always possible to prevent pressure ulcers in particularly vulnerable people, but it’s the first stage of the treatment and nursing have a very hight responsibility with this.

STAGES:

CHARACTERISTICS OF DISEASES IN THE ELDERLY. THE GERIATRIC SYMDROMS

A geriatric syndrome is a illness situation expressed by a multiple symptoms caused by a variety of disease.

GERIATRIC SYNDROMES are common clinical conditions that don't fit into specific disease categories but have substantial implications for functionality and life satisfaction in older adults. Besides leading to increased mortality and disability, decreased financial and personal resources, and longer hospitalizations, these conditions can substantially diminish quality of life.1

It’s necessary to value the meaning of these symptomps and where they are coming.

The Geriatric Symdroms are:

1. Inmovility
2. Falls
3. Incontinence
4. Intellectual Impairment
5. Infections
6. Inanition
7. Impairement of vision and hearing
8. Irritable colon
9. Isolation
10. Iatrogenesis
11. Inmune deficiency
12. Impotence

There are a serie of elements that are important to consider when you have to work with elderly:

The heterogeneity of the older population because there are differents characteristics between all of them.

Also, the disease presentations are atypical, it has differents symptoms comparing with adult population.

They are fragile people and all the risk factors are increased.

More over, elderly have a lot of diseases at the same time and takes a lot of medications which produces secondary effects and affect  a lot of organ functions.

Their diseases have tendence to chronicity and are related to discapacity.

Nurses must recognize geriatric syndromes and apply best practices to the care of older adults to achieve the best outcomes possible

NURSING CARES

As is well know for student’s nursing, there are 14 basic human needs as told once Virginia Henderson.

Explaining all of them could take a very long time. In fact of this, Here I will go to explain with more details just the need of sleep and rest.

Knowing if a older people is independent to do this activity is important to revise if they are able to sleep easily and.feel rested after to be sleeping during 6 – 8 hours. Also, they have to prepare confortable areas without noise and lights.

Realise some moderate physic activitie may improve their sleeping quality.

They should known they have to consult the geriatrician if they feel acute changes in their sleeping patron.

They are dependent if their sleeping is under 5 hours and they have sleep interruptions in the night.

During the day, the could feel irritable and tired to do the daily routine.

Also, they doesn’t know how prepare a confortable area with conditions to sleep and they self medicate and do any physic activity.

The nursing assessment on these case is to advise about the intake of liquids and how get the ideal conditions to sleep and .improve the physic activity.

GLOBAL GERIATRIC ASSESSMENT

The MNA is a scale of assessment of nutritional status. Used to view the nutritional status of the elderly and is so important because it can make research studies. 

For example: 

The objective of a study was to determine the prevalence of the risk of undernutrition by evaluating the nutritional status in a representative sample of older people in Ourense. The total sample was 728 subjects (63,6% woman and 36,4% men) with a mean age of 80,7±7,4 years old. Anthropometric parameters (weight, distance heel-knee, calf circumference and mid-arm circumference) were determined and the MNA (Mini Nutritional Assessment) was applied and 70% of individuals with nutritional problems were identified (57.5% with nutritional risk and 12.5% malnourished). The subjects aged between 65 and 70 years old, 81 and over, and females presented higher nutritional problems. The items that were observed most frequently in the studied population and therefore responsible for this nutritional situation were the involuntary loss of weight, consumption of at least one serving of protein per day, low daily liquid intakes, loss of appetite, taking more than 3 prescription drugs per day and to have a limited mobility.

The research is in this page, I recommend to read it because it's very interested.  

http://www.scielo.org.ve/scielo.php?pid=S0004-06222009000400006&script=sci_arttext

THEORIES OF AGING. The Somatic Mutation Theory of Aging

This theory states that an important part of aging is determined by what happens to our genes after we inherit them. From the time of conception, our body's cells are continually reproducing. Each time a cell divides, there is a chance that some of the genes will be copied incorrectly, this is called a mutation. Additionally, exposures to toxins, radiation or ultraviolet light can causes mutations in your body's genes. The body can correct or destroy most of the mutations, but not all of them. Eventually the mutated cells accumulate, copy themselves and cause problems in the body's fnctioning related to aging.

PHYSIOLOGIC CHANGES. Aging changes in skin

Sking disorders are so commun among older people that it is often difficult to tell normal changes from those related to a disorder. More thatn 90% of all older people have some type of skin disorder.

Skin disorders can be caused by many conditions, including:
- blood vessel diseases such as arteriosclerosis
- diabetes
- heart disease
- nutritional deficiencies
- obesity
- reactions to medications
- stress

Other causes of sking changes:
- allergies to plants and other substances
- climate
- clothing
- exposures to industrial and household chemicals
- indoor heating

Sunlight can cause:
- loss of elasticity
nocancerous skin growths
pigment changes such as liver spots
thickening of the sking

PREVENTION

Because most skin changes are related to sun exposure, prevention is a lifelong prcess.
Good nutrition and adequate fluids are also helpful. Dehydration increases the risk of skin injury. Sometimes nutritional definciencies can cause rashes, skin lesions, and other skin changes, even if you have no other symptoms.

Keep skin moist with lotions and other moisturizers. Dont use soaps that are heavily perfumed. Bath oils arent recommended because they can cause you to slip and fall. Moist skin is more comfortable and will heal more quickly.

INTRODUCTION TO GERIATRIC NURSING.

Geriatric is sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. 

It should be confused with gerontology because it just study the process of aging in general.

Geriatricians distinguish between diseases and the effects of normal aging.

The medicine in older adults must be different from young adults because the elderly have a atipic symtoms, less recuperation ability, polypharmacy and a lot of pathologies together.

Nurses who work in the field of geriatrics are a high-demand practice area, because older people are more likely to require health services. Half of all hospital admissions are for patients over age 65.

In addition, geriatric nursing is a fast-growing career, because people are living longer.

Geriatric nurses are educated to understand and treat the often complex physical and mental health needs of older people. They try to help their patients protect their health and cope with changes in their mental and physical abilities, so older people can stay independent and active as long as possible.

A geriatric nurse will:

·  Assess the patient’s mental status and cognitive (thinking) skills

· Understand patient’s acute and chronic health issues

· Discuss common health concerns, such as falls, incontinence, changing sleep patterns and sexual issues

· Organize medications

· Educate the patient about personal safety and disease prevention

· Explain and recommend adjustments to the patient’s medication regimen to ensure adherence

·Link the patient with local resources as needed

Many older people have health conditions that do not require hospitalization, but must be treated with medication, changes in diet, use of special equipment (such as a blood sugar monitor or walker), daily exercises or other adaptations.

Geriatric nurses help design and explain these healthcare regimens to patients and their families. They can link  families with community resources to help them care for elderly members