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/