GERIATRIC RESOURCEs. LEVELS OF CARE

REFLECTION

Hip fracture is one of the main diseases causing disability in the elderly.

Recovery geriatric units or medium-stay units are responsible of the rehabilitation of this pathology. Rehabilitation is focused in recovering the lost function for the elderly to have a better quality of life and he does not need to be institutionalized.

In these units a comprehensive assessment of the elderly is made. Each professional evaluates their specific area and then they are coordinated to take all necessary decisions with the patient.

After the discharge they will monitor the patient progress.

The hip fracture increases more and more among the elderly. According to the study of  "Injuries from falls are increasing in the elderly." The results of this study are that from 1970 to 1995/1997 hip fractures have become of 1857-7122.

So care level workers have prevent this disease as much as possible.

http://www.infodoctor.org/bandolera/b66s-3.html

http://www.google.es/search?hl=es&source=hp&q=niveles+asistenciales+en+geriatria&gbv=2&oq=niveles+asistenciales&gs_l=heirloom-hp.3.3.0l9.4878.8278.0.11042.21.10.0.11.11.0.175.1091.4j6.10.0...0.0...1ac.1.12.heirloom-hp.O2JfTtCBcXM

HEALTH PROMOTION AND HEALTH MAINTENANCE.

HEALTH EDUCATION IN A GERIATRIC PATIENT

The health education is important, but is it even more important in geriatric patients?

There is a growing elderly population and many studies are often made about the living conditions of this population. We are interested in increase longevity in geriatric patients and in making the living conditions as good as possible.

Therefore it is important the health education. Since we prepare the patients to take care of their health and to be able to prevent some diseases.

In geriatric patients, in my opinion, it is even more important the health education. In addition there are several studies supporting that health education has an impact on the geriatric patient. I quote one of them in the bibliography that was performed in Asturias and in the conclusions there were good results.

http://www.bibliotecacochrane.com/BCPRECORDSTOP.ASP?SessionID=6835650&LineID=3957670&SearchFor=%28EDUCACION+ANCIANOS%29%3ATI

http://www.bibliotecacochrane.com/BCPGetDocument.asp?SessionID=%206835650&DocumentID=r891

http://www.google.es/search?hl=es&source=hp&q=educacion+para+la+salud+en+los+ancianos&gbv=2&oq=educacion+para+la+salud+en+los+ancianos&gs_l=heirloom-hp.3..0i30.742.6237.0.6416.39.32.0.6.6.3.372.4901.8j16j6j2.32.0...0.0...1ac.1.12.heirloom-hp.IhN1wenxR5Y

PALLIATIVE CARE

END-OF-LIFE CARE.

The conspiracy of silence is an implicit or explicit agreement, by family, friends or professionals to alter the information given to the patient in order to conceal the diagnosis, prognosis or severity of the situation.

If the family asks us not to say anything to the ill (be participants in the conspiracy of silence):

• We do not say anything to the patient whenever he does not make a direct question
• Otherwise, he will be informed with care and detail required by the situation and until what the patient decides to want to listen.

I have reviewed studies in which it is said that in Spain around 50-70% of patients with cancer want to receive their diagnosis. And regarding the family between 61-73% prefer not to unveil their diagnosis to family members.

In Spain, unlike anglo / north patients, people prefer less detailed information about prognosis or other disease-related aspect. Regarding the Spanish patients´ family they wish to know all the information related to the patient.

The study says that health professionals should assess the needs of information individually and continuously over the time.

Do you think is better the patient not to know what is happening?

I believe that as health professionals we are between a rock and a hard place in this situation, because our duty is to tell the patient the truth about his process within the limits of nursing.

I also believe that everyone has the right to know what is happening. And in cases like these, which are patients who have cancer and that the prognosis is bad.

If the patient decides to know it, I think noone is who to decide for him.

 If he finds out that he certainly will die in a short time he may do things he would like to do before going to another world.

I think if a patient asked me and his family had told me not to say anything about the disease I would give a little explanation at this moment but then I would talk to the family. I would make them see that the patient is the one who is going to die and he must be the one who decides what he wants in his life.

http://www.guiasalud.es/GPC/GPC_428_Paliativos_Osteba_compl.pdf

http://portal.guiasalud.es/web/guest/catalogo-gpc

GERIATRIC SYNDROMES: URINARY INCONTINENCE.

INCONTINENCE IN THE ELDERLY

It is defined as urinary incontinence the involuntary loss of urine in quantity or frequency enough to be a problem for the person who suffers it, as well as a possible limitation of their activity and social relationships.

The elders affected feel a sudden need to urinate but they are unable to hold urine.

Who recognizes it as a problem with high-impact physical and psycho-social.

Urinary incontinence worries in the elderly because it produces many pathologies. The pathology of the skin more often associated with incontinence is the formation of ulcers. But I wanted to investigate if it causes dermatitis.

Searching in pubmed I found an article which talks about incontinence associated with dermatitis.

It is a study in the UK in which we talk about the elderly who suffer from incontinence. On it, it is said that due to this disease patients are at risk of painful dermatitis.

It claims that to use an effective sunscreen provides protection against dermatitis in these cases.

I will investigate what creams are provided in the hospital for this type of dermatitis and if they really have an effect as it is said in this article.

http://www.ncbi.nlm.nih.gov/pubmed/?term=problems+skin+by+incontinence+urinary

http://www.ncbi.nlm.nih.gov/pubmed/22585017

http://portal.guiasalud.es/web/guest/home;jsessionid=a9f587c25b8fe07c599255080d1c

GERIATRIC SYNDROMES: CONSTIPATION.

CONSTIPATION AND FECAL INCONTINENCE

The etiology of diarrhea is due to various causes. We must find the problem or illness and act to stop the diarrhea because it can lead to many problems in the elderly, even death.

But if it is not treated in the elderly and it is severe, it causes loss of water, sodium, potassium ... This can lead to a drop in blood pressure affecting all organs.

The geriatrician Salvador Altimir conducted a study in the United States. The conclusions were that half of diarrhea and gastroenteritis occur in people over 75 years.

So us, as professionals, we must detect it early to prevent further complications.

We will detect if the patient usually suffers an alteration with stool or if he really suffers diarrhea.

We will check the time of the table evolution. If there are signs of dehydration, if there are parasites in their feces. And we will make a syndromic classification of diarrhea.

And we will act consequently depending on the patient's chart.

http://www.indogastro.org/downloads/pbgcap.21.pdf 

http://ww42.excelenciaclinica.net/?search=diarrea+en+el+anciano&submit=Search&ts=fENsZWFuQmxhY2t8fGY3YjAyfHxidWNrZXQwNTl8YnVja2V0MDQ5fHwyMzg3OTA2OHx8NTE5MTIzMTg2YzdjMnx8fDEzNjg0NjYyMDAuNDY3MXxkYTAyNDdmYTYyY2Q5NTZiMTZlMWRiZThmMjJlODRmZWI0NjgxNzc3fHx8fDF8fA%3D%3D&jsv=2&token=AG06ipBH-RxsP3JlkJSsErqGLcDJsU5C1AoTCKyx9O7Nk7cCFYg1fAodj34AmRACGAMgADgwQLDYqaeBmYTsAlChn8wIUPbaxAlQqKOoDlDS77MOUL_v4g5QpPmYD1C_-5gPUO7-mA9Q0_-YD1DVvJkPUIHczg9Qo9HXD1Co9NsPUKn02w9QzLrcD1D-q_YPUMPq-xBQjbu1EVDOu7URUOC7tRFQ5ru1EVDexbgTUL7t_xNQ5u3_E1CS7v8TUIrrtxVQjeu3FVC85ekVUMadjhZQnOuEG1CfrrkdUKL01CBQ7IL9IFCgupEhUMHZkSFQ0dmRIVDp2pEhUP7ngihQ87GtKVCX2dlfUNiPk48BULyQk48BUMuQk48BUL20lJUBUPu7lJUBUIXdiKIBUJm9qqcBUNuV88ABUPGX88ABUL-Z88ABULjE4MIBUOHxsMcBULHl5fUBUJDzvJoDUKXnyJoDUJaE050DUKeF2J0DULfC2J0DUKTG2J0DccUvCvawSH8BggETCNvy9e7Nk7cCFUISfAodP2QAy5EBz5VycSxsICQ

http://www.vivirmejor.com/la-diarrea-puede-llegar-a-ser-mortal-en-ancianos

GERIATRIC SYNDROMES: FALLS AND INSTABILITY.

INSTABILITY AND FALLS IN THE ELDERLY

We know that falls are a frequent occurrence among the elderly (13-25% of those older than 65 years, 31-35% older than 85 years), more in the institutionalized (up to 50%).

We also know that when there is a fall in the elderly, consequences may appear physical, psychological and social.

In a prospective study of 7900 patients it was found that there are risk factors that were associated with an increased risk of falls. If in patients coincides the number of risk factors, incidence increased.

Knowing that the main triggers of fall risk are:

• Over 65
• Alteration of the stability and march
• Previous falls
• Number of drugs consumed: 4 or more
• Frail elderly
• Living outside the family
• Muscle weakness
• Deficit of march and balance
• Cognitive impairment
• Polymedication
• Decreased vision
• Acute and chronic pathologies
• History of falls

Knowing all this data when we are in hospital nursing we must use our knowledge about this issue, since the majority of the patients we will attend will be elderly.

Knowing all these data we are going ahead than other professionals.

We will check if the patient has one or more of the factors listed above. So we will know the right way to serve him by providing the necessary and reducing the risk of patient falls.

We will also provide information of interest to the family for the elderly to be more secure at home and there is also less risk of falls.

http://www.infodoctor.org/bandolera/b85s-3.

htmlhttp://escuela.med.puc.cl/publ/manualgeriatria/PDF/InmovilidadCaidas.pdf

GERIATRIC SYNDROMES: DEMENTIA AND DELIRIUM.

DEPRESSION

Within the secondary dementias we have psychiatric depression, conversion reaction and schizophrenia.

In geriatric patients depression needs to be treated in a very meticulous way. It should be treated as soon as the first symptoms begin as it is one of the risk factors and it may trigger dementia, because depression has a negative impact on cognitive functions.

In addition, patients with depression tend to have more subjective complaints of memory loss, they often have psychomotor retardation and low motivation in conducting the test.

You have to make cognitive behavior therapy with depressed patients. This therapy focuses on changing dysfunctional behaviors, negative thoughts and maladaptive attitudes.

When analyzing depressive symptoms we see loss of interest, loss of energy, difficulty in thinking ... So it is easy that the patient begins to make little exercise, to go less to the street, to lose interest in what he had before .... and consequently dementia arrives.

http://demencias.sen.es/wp-content/uploads/2013/02/depresion_y_alzheimer.pdf

http://www.guiasalud.es/GPC/GPC_424_Dep_Adult_compl.pdf

http://portal.guiasalud.es/web/guest/catalogo-gpc