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

UNIT 11: IMMOBILITY

The mobilization capacity is an indicator of the level of health of the elderly and their quality of life, since it determines its degree of independence. Immobility can be defined as the decreased ability to perform activities of daily living by deteriorating motor functions.

In aging, changes are given mostly to physiological level. The major physiological changes include decreased muscle mass and the decline of aerobic capacity by a decreasing in cardiac output. Together with the existence of diseases such as arthritis, osteoporosis, or COPD.

The best and main treatment for immobility is prevention, promoting physical activity and exercising the patient will better adapted to his environment, as well as detecting early disabling diseases and associated environmental factors.

I believe that immobility is one of the most common problems in the elderly, and from my point of view,  It should not be allowed. It cannot be avoided in all cases, but it is true that it depends largely on our performance as healthcare professionals.

As nurses, we should encourage the elderly to remain more independent, participating in activities according to their abilities. As well as prevent the immobility, this way the elderly will feel more active, and it will be good for his state of mind.

Bibliography

• Torres Haba R, Nieto de Haro MD. Inmovilidad. Tratado de Geriatría para residentes. Madrid: Sociedad española de geriatría y gerontología. 211-216.

UNIT 10: PRESSURE ULCERS

Pressure ulcers is an issue that every nurse must know in depth, since we are the main responsible for prevention and treatment. Pressure ulcers is a problem that requires time, and is quite common among hospitalized elders, specially those who remain in bed.

Most pressure ulcers are preventable, so it is important to create education and prevention strategies that complete the different levels of care, always based on the best available scientific evidence. All patients must be assessed by scales of assessment of risk in order to initiate preventive measures as soon as possible.

On the basis of the best measure against pressure ulcers is prevention, which is the work of nursing, also note the lack of unified criteria to plan the cures between differents proffesionals.Some studies have explored the knowledgehe from nursing staff on the recommendations relating to prevention and treatment of pressure ulcers. The results found gaps in knowledge and related deficiencies in its application. In my opinion, and as well as it reflects the study, preventive measures are more standardized than the healing.

In terms of prevention, this figure highlights the points where ulcers occur the most, due to pressure:

Bibliography

• Juan Ángel Hernández Ortiz. Gerokomos [revista en Internet]. 2009 sept [10 de abril del 2013]; 20(3). Disponible en: http://scielo.isciii.es/scielo.php?pid=S1134-928X2009000300007&script=sci_arttext

UNIT 9: GERIATRICS SYNDROMES

The main pathology affecting the senescent do not differ from those which may affect other age groups. There are few diseases that only affect the persons recognized as elderly people. However, there are a number of characteristic elements of the geriatric pathological processes that determine the specificity of care and any professional who work in gerontology what should bear in mind.

Major general aspects of diseases of the elderly are:

• tendency to chronicity.
• greater use of health care resources.
• less favorable prognosis.
• pluripathology and polypharmacy.
• heterogeneity and fragility.

On geriatric pathologic processes, the symptoms did not appear clearly. However, there are a number of symptoms that recur in various diseases, although not characterized by being of a specific one. The main symptom is the pain.

As stated by the article mentioned in the bibliography, the pain could and should be treated. I agree that medical personnel must not allow the elderly suffer, since there are therapeutic proposals to alleviate it. We cannot allow that pain is considered something normal in the elderly.

The geriatrics syndromes are expressed by a set of symptoms depending on the disease situation. There are a set of tables originated by the concurrence of a number of diseases which have their expression through pathological pictures not included in common diseases. It is a common way of presentation of the diseases of the elderly and require a care assessment of its meaning and etiology to give a proper treatment.

The geriatrics syndromes were described by Kane in 1989. There are:  inmobility, instability, incontinence,    intelectual impairment, infection, inanition, impairment of visión and hearing, irritable colon, isolation,        iatrogenesis,  inmune deficiency,  impotence.

Bibliography

• Cecilio Álamo. Opioides y dolor crónico en el paciente geriátrico. Del reto al éxito [Internet]. Disponible en: http://scielo.isciii.es/pdf/dolor/v15n7/editorial.pdf
• Infermeravirtual.com [Internet]. Síndromes geriátricos. Col-legi oficial Infermeres i infermers Barcelona. [acceso 2 de abril de 2013]. Disponible en: http://www.infermeravirtual.com/es-es/situaciones-de-vida/vejez/informacion-relacionada.html

UNIT 8: BASIC NEEDS IN THE ELDERLY

The nursing process is the application of the scientific method in practical health care. This method allows nurses to provide care in a rational, logical and systematic way. This process is divided in five parts: nursing assessment, diagnosis, planning, implementation and evaluation. 

To conduct the nursing assessment we focus on the 14 needs of Virginia Henderson, which are as follow:

As the article mentioned in the bibliography shows, elderly people care has become a dynamic field, because of the patient's needs and the professional´s requests needed to provide the right answers in our environment. I agree with this afirmation. I totally agree with the article, as life expectancy has increased in recent decades and have released new therapies and treatments that make it necessary that health professionals acquire new knowledge continuously.

Bibliography

• Vernet Aguiló F. Conceptos básicos de enfermería en la atención gerontológica según el Modelo V.Henderson. Gerokomos. 2007; v.18 (nº2). Disponible en:  http://scielo.isciii.es/scielo.php?pid=S1134-928X2007000200004&script=sci_arttext

UNITS 4-7: OVERALL GERIATRIC ASSESSMENT

The overall geriatric assessment covers various areas: 

This valuation constitutes a diagnostic process that detects and quantifies the problems, neccesities and abilities of the elder in the above areas.

The following table shows the different scales used in the geriatric assessment, in the four areas.

Focusing on the functional sphere, highlighting the assessment focuses on collecting information about the ability of the elderly to perform their usual activity and maintain their independence over the medium where their are located

Daily activities are divided into basic and instrumental. There are different scales for each case.

Some studies related functional decline with some pathologies. 

In the article mentioned in the bibliography the functional decline in the elderly within a period of two years is studied. There were two groups: one of independent elders to the activities of everyday life and one of those who were dependent. Within each group, there were older people with cognitive impairment; others with depressive symptoms; and a third part, who suffered from cognitive impairment and depressive symptoms.

The results concluded that suffering, at the same time, cognitive impairment and depressive symptoms are risk factors for the functional decline in dependent elder to the activities of everyday life. On the other hand, cognitive impairment is the factor that leads to a greater decline in elderly with previous dependence on some activities of every day life.

To conclude, note that cognitive impairment is the factor that affects the most to the degree of dependence of the elderly population.

Bibliography

• Mehta KM, Yaffe K, Covinsky KE. Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People. J Am Geriatr Soc. 2002; 50 (6):1045-50. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939718/?tool=pubmed

UNIT 3: THEORIES OF AGING

Aging is the process of becoming older, a process that is genetically determined and environmentally modulated. There are several theories that try to explain this process.

The biological theories of aging attempt to explain why the physical changes occur. On the other hand, the psychosocial theories try to explain why older adults have different responses to the aging process. I am going to focus this post on one of the biological theories, called the Free Radical Theory.

This theory provides an explanation for cell damage. Free radicals are unstable molecules produced by the body during the normal metabolism or exposure to radiation and pollution. Excessive accumulation of free radicals is suspected to cause damage to the cells, DNA and the immune system, contributing to the physiological changes of the aging and a variety of diseases. Individuals who support this theory propose that the number of free radicals could be reduced by the use of antioxidants and vitamins A, C and E. 

An example of this is Hiromi Shinya, a Japanese doctor who wrote “The Enzyme Factor”.  In this book he indicates that there is a mother enzyme that determines the duration of our lives and has the ability to become any type of specific enzyme in response to a particular need of the organism. Therefore, health depends on our capacity to keep the mother enzymes of the body. One of the steps is to avoid free radicals, since they consume the enzymes. However, our life style is full of elements that generate them: stress, pollution of the air, electromagnetic waves, viral or bacterial infections, and exposure to radiation. In addition, drinking, smoking, eating foods with additives, rusty food and drugs also originate harmful free radicals, which increase the chances of contracting diseases. To save the enzymes it is necessary to create an intestinal environment that produces "good" bacteria which produce antioxidant enzymes. 

Bibliography

• Hiromi Shinya. La enzima prodigiosa. 1ª Edición: Aguilar; 2013.

UNIT 2: PHYSIOLOGICAL CHANGES OF THE AGING

According to the WHO, aging is a physiological process that begins with the birth and continues throughout the life cycle. When reaching the last part of the cycle, a lack of adaptation of the organism to the environment appears and, with it, diseases. It is individual and depends on each person.

It is characterized because it occurs in all living beings, emphasizing on the last years. However, it happens neither at the same time nor in the same way. It should be measured from a triple perspective: biological, psychological and social.

There are some physiological changes that occur during the aging, in which the nurse can contribute to improve them. These changes occur in different systems, standing out: integumentary system, musculosketal system, respiratory system, urinary system, nervous system, cardiovascular system and gastrointestinal system, mainly. 

While it is true that the physiological changes associated with aging are difficult to avoid, the nurse has an important role to achieve the psychological and social consequences associated, minimizing them as much as possible, improving the patients' quality of life.

For instance, by highlighting the importance of providing adequate fluid to prevent the dehydration or reducing the pressure over the bony prominences, to prevent skin breakdown. It is also necessary to provide assistance and modify physical environment by initiating safety precautions to decrease the risk of falls.

Therefore, I consider that the nurse must know in deep all changes that could take place, as well as the interventions that could improve them.

In terms of social perspective, one of the main problems of the elderly is depression. In many cases it is untreated, even when it is considered as an important part of the process. The nurse is a key person in the early detection and treatment of this disease.

As explained in the article, and according to the WHO, since we are born begins the process of aging. This is not a bad thing, but quite the contrary; aging is an indicator of the improvement of health in the world. It is necessary to meet the goal of keeping the aged persons as independent as possible, maintaining their quality of life.

Bibliography

• Bengoa J. ¿Qué es envejecer? An Venez Nutr [Revista en internet]. 2001 ene [2 de marzo del 2013]; 14(1). Disponible en: http://www.scielo.org.ve/scielo.php?pid=S0798-07522001000100007&script=sci_arttext
• WHO [Internet]. Disponible en: http://www.who.int/features/factfiles/ageing/es/

UNIT 1: GERONTOLOGY AND GERIATRICS

The increase in life expectancy and the reduction of mortality have produced an increasing of the ageing of the population.

Due to this, it is necessary to pay more attention to the healthcare quality of this population group, which has made possible the development of Geriatrics (branch of medicine that studies the acute and chronic diseases in elderly patients in its clinical, therapeutic, preventive and social aspects). 

It is important to differentiate this concept from Gerontology: science that studies the aging process in general, as well as biological, psychological and social changes that occur in old age.


The main objectives of the Geriatrics are: 

• Preventing the elderly from becoming a social burden 
• Improve the quality of life, instead of prolonging it.

This will be achieved through a series of functions and specific nursing care, like preventing complications, management of problems (incontinence, dysphagia...) and health education, both to the patient and his family, mainly.

Different situations of elderly will be established for this purpose:

• Healthy older person: does not have any degree of functional, social or mental problems.
• Sick elder: elder healthy with acute illness.
• Fragile or high-risk elderly: one or several diseases which keep them independent but with a high risk of becoming dependent.
• Geriatric patients: present at least 3 of this criteria (more than 75 years, relevant pluripathology, main disease with debilitating character, social problems and mental pathology in relation to their State of health).

In my opinion, it is very important to know how to detect the groups of risk, in order to respond to their needs in an efficient way. That will allow us to prevent or extend, as much as possible, the evolution of these high-risk patients, improving their quality of life.

Bibliography

• Instituto Nacional de Estadística (National Statistics Institute) [sede web]. Madrid: Ministerio de Sanidad y Política Social; 2012. Disponible en: http://www.ine.es
• Egurza M, Notivol P. La enfermería en la asistencia sanitaria al anciano. Anales. Universidad de Navarra. Disponible en: http://www.cfnavarra.es/salud/anales/textos/vol22/suple1/suple10.html