UNIT 18: GERIATRIC RESOURCES

In our society the population is very old so they need the best health care system to cover their needs.

• Acute Geriatric Units.
• Geriatric unit for functional recovery.
• Geriatric day hospital.
• Home-hospitalization.

The nurse attends patients at all of these levels. The main objectives are the following:

• To avoid the chronicity and treating psychopathology resistances: intensify and complete therapeutic actions in those patients requiring treatment of longevity, among other activities.
• Development of individualized plans for treatment and rehabilitation.
• To promote the acquisition of skills that enhance the autonomy of the patient.

The nurse is a key figure in taking care of the patients and monitoring them at all levels, among other functions, depending on the level where she works. 

Bibliography

• Fernández Fernández M, Solano Jaurrieta J. Niveles asistenciales en geriátria. Tratado de geriatría para residentes. Disponible en: http://www.segg.es/busqueda.asp?busqueda=niveles+asistenciales

UNIT 17: HEALTH PROMOTION

The health landscape is no longer just health care and today also includes other aspects such as prevention, promotion, rehabilitation and education.

The preservation of health and functional independence are the most important aspects of the promotion of health in older adults.

Prevention must be directed toward three aspects:

• The education of the general population on the recognition of the risk factors and necessary education for their correction.
• The recognition of high-risk groups.
• Prevention in people with known illnesses.

The health education means a new approach in healthcare, in the understanding of the health process and goals to achieve. It is an educational process aimed primarily to enhance, promote and educate those factors that directly affect the population in general and the older citizen in particular.

The health education, as a tool for the promotion of health, will have to deal with creating learning opportunities to facilitate behavioral changes or healthy lifestyles.

This means an overcoming of traditional paper that has been attributed to the health education, limited primarily to change the behaviour of individuals on risk, becoming a powerful instrument for the community.

To conclude, I consider that the nurse has an important role in society, being qualified to promote healthy lifestyle in order to prevent diseases in different areas.

Bibliography

• Comisión de ancianidad. Revista argentina de cardiología. [revista en internet]. 2001 [25 de abril del 2013]; 69. Disponible en: http://www.sac.org.ar/files/files/comisiondeancianidad.pdf

UNIT 16: ENF-OF-LIFE CARE

As a future health professional, I believe that it is very important to know what a terminal illness is and try to achieve a better knowledge about the process, since the therapeutic approach will be different, depending on the situation.

A terminal illness is a progressive and incurable disease that does not respond to the specific treatment. It has a prognosis of less than 6 months of life and represents a huge emotional impact in the patient and his family.

I believe that the role of the nurse is especially important when dealing with  this type of diseases, as a healthcare professional.

We should know how to communicate with the patient and his family, especially in these cases. It will not be easy. The family will find difficult to assimilate the situation. On the other hand, they will want it to finish soon. Health professionals must support them to accept the situation without feeling guilty. It is important that both, the family and the patient, feel supported by us. We must avoid a very typical error in these cases: spend the shortest possible time in the patient room.

Bibliography

• Ministerio de Sanidad y Consumo. Guía de práctica clínica sobre cuidados paliativos. 1ª Edición. Vitoria-Gasteiz: Servicio Central de Publicaciones del Gobierno Vaco; 2008.
• Nancy Guinart. Cómo atender a la familia del enfermo terminal. Revista cubana de medicina general integral. Marzo 2006. 22 (1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252006000100010

UNIT 15: URINARY INCONTINENCE

Urinary (or bladder) incontinence happens when you are not able to keep urine from leaking out of your urethra, the tube that carries urine out of your body from your bladder. You may leak urine from time to time. Or, you may not be able to hold any urine. That could cause a social and psychological problem for the person suffering from it, as well as a possible limitation of the activity and relationship.

I am going to focus this post on the treatment of the urinary incontinence. Wich includes the following:

CONSERVATIVE TREATMENT

• Electrostimulation: it consists in the use of a device that, by using controlled electric shocks, exercises the muscles of the pelvic floor, and therefore, the contractions of the detrusor muscle will be suppressed. It simulates the Kegel exercises.

• Modification of the environment: trying to facilitate access to bathroom, avoiding domestic physical barriers and dispose of substitute (urinals, sanitary...) or some kind of adaptation.

PHARMACOLOGICAL TREATMENT

SURGICAL TREATMENT 

Surgery is considered an adequate treatment in patients, where conservative treatment has failed.

Bibliography

• Robles J. La incontinencia urinaria. Anales Sis San Navarra [revista en la Internet]. 2006 Ago [10 de mayo del 2013]; 29(2): 219-231. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272006000300006&lng=es 

• Perdidasdeorina.com [página web]. [acceso 31 de Marzo de 2012]. Definición de incontinencia urinaria [1]. Disponible en: http://www.perdidasdeorina.com/Templates/definicion.htm

UNIT 14: CONSTIPATION

Constipation is defined as the evacuation of feces excessively dry, scant or infrequent.

Constipation is more common in women than in men. It represents one of the major geriatric syndromes by its prevalence, its serious complications and its significant impact in the quality of life of the elderly.

I consider that the best measure against constipation is prevention, following these steps: 

• Try to increase your daily fiber intake 
• Consume 2 liters of fluid per day
• Physical exercise
• Rating the pharmacological treatment the patient follows, because it can result in constipation.
• Avoid using laxatives
• Adquisition of correct depositional habits

Bibliography

• Juarranz Sanz M, Calvo Alcántara M.J,  Soriano Llora T. Tratamiento del estreñimiento en el anciano.  Revista de la SEMG. Nov 2003;58: 603-6. Disponible en:  http://www.medicinageneral.org/revista_58/pdf/603-606.pdf

UNIT 13: FALLS AND INSTABILITY

Falls are a major cause of injury, disability and even death in the elderly.  Falls can cause moderate to severe injuries, such as hip fractures and head injuries, and can increase the risk of early death. 

This is a problem with great significance in our society. It is expected that one third of people older than 64 years living in the community, fall within the period of one year. Falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma. Several studies agree that the elderly have an increased risk of falls.

The nurse has a fundamental task in the prevention of this problem in the different levels of care. In the case of primary care, as a professional who performs home visits, she can detect and modify aspects that increase the risk for the elderly to fall.

How can older adults prevent falls?

• Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance.
• Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that might cause side effects or interactions such as dizziness or drowsiness.
• 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. 
• Improving the lighting in their homes.
• Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.

As nurses, we must be aware of these details, even more if possible,  to prevent the problem and its consequences.

Bibliography

• Zenewton André da Silva Gama, Antonia Gómez-Conesa. Factores de riesgo de caídas en ancianos: revisión sistemática. Rev Saúde Pública 2008;42(5):946-56. Disponible en: http://www.scielo.br/pdf/rsp/v42n5/6793.pdf

UNIT 12: COGNITIVE IMPAIRMENT AND DEMENTIA

Cognitive impairment and dementia are one of the most important public health problems in developed countries. They can be attributed to multiple factors linked to aging.

I am going to focus this post in the alzheimer disease. Alzheimer disease is the most common cause of dementia, Alzheimer is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe. 

Nurses can find patients with this disease in the different levels of care. Depending on the state of the disease, it is not easy to deal with it, so nurses need to know what the main symptoms and consequences of this pathology are. 

I think that, once again, the key word is prevention. Nurse shares a lot of time with patients, so she has to be careful when working with old persons to find any symptoms, such as loss of memory or difficulty in retaining information. 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.

Once the disease has been diagnosed, nurse also has a fundamental role in the care of the affected family. As I mentioned earlier, it is not always easy to deal with these patients. 

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. This is going to be hard for the family.

In these cases the nurse should show them support at all times, teaching them how they can help their family member.

Bibliography

• Balbás Liaño V.M. El profesional de Enfermería y el Alzheimer. Nure Investigación (13), 2005. 
  Disponible en: http://www.nureinvestigacion.es/FICHEROS_ADMINISTRADOR/PROTOCOLO/protocolo%2013.pdf