GERIATRIC SYNDROMES: IMMOBILITY.

IMMOBILITY CAUSES IN ELDERLY PATIENTS

Among the most common neurological diseases related to immobility we find the Parkinson. Immobility exaggeratedly deteriorates the quality of life for seniors and negatively influences their health resulting in disease.

Parkinson's disease is a degenerative disorder of the central nervous system that is somehow related to immobility. This disease belongs to the group of movement disorders.

Parkinson patients have fatigue. Recent studies have shown that people with Parkinson have loss of nerve endings that produce norepinephrine. Norepinephrine is totally mind related to dopamine which is the main chemical messenger of the sympathetic nervous system. (it controls many body functions). The loss of norepinephrine might help explaining several of the non-motor features of Parkinson's disease, including fatigue.

So I realized that immobility is partly related to one of the symptoms that may accompany Parkinson's disease (fatigue). Since they need to do more effort to practice more exercise and be mentally active.

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

www.bibliotecacochrane.com/

CARE OF AGING SKIN AND MUCOUS MEMBRANES.

REFLECTION

The venous leg ulcers are a type of injury that affects up to 1% of the adults living in developed countries at some point in their lives. Many of these wounds are colonized.

When the wound becomes infected antibiotics must be used to eradicate the infection. The oral antibiotics are effective. However it is not known if topical antibiotics promote the ulcers healing.

So, I reflect on this and I think in the amount of money that is being lost in hospitals using topical antibiotics in venous ulcers. I think we should use in the patient´s ulcers what is really scientifically proven that works.

All health professionals should work together to review studies and find out what are the topical antiseptics that actually do work. (If any exist)

So far I've reviewed several databases and as I have said before there is no scientific evidence on the subject.

http://www.bibliotecacochrane.com/BCPGetDocument.asp?SessionID=%206792863&DocumentID=CD003557

http://www.ulceras.net/monograficos/ulcVasculares05.htm

OVERVIEW OF THE DISEASES OF THE ELDERLY.

GERIATRIC SYMDROMES
Is it important nurse to know how the muscle contractures may affect geriatric patients?

Muscle contractures involve the persistent contraction of a muscle.

In the elderly musculature has lost power and if they practice exercises that are too strong for them contractures may be induced.

In addition, contractures in these types of patients are associated because they are highly correlated with musculoskeletal diseases. (eg, arthritis, burns ...).

The areas that are usually affected are the back, arms and legs. What in the elderly causes loss of mobility due to pain and this may trigger in another pathology.

Therefore, it is important the nurse to know what a muscle contracture is, and how it affects geriatric patients unlike other patients.

http://www.med.unne.edu.ar/kinesiologia/catedras/fisioterapia/mono06/00106.pdf

http://www.bibliotecacochrane.com/BCPGetDocument.asp?SessionID=%206835650&DocumentID=CD007455

NURSING CARE IN THE ELDERLY.

NURSING ATTENTION PROCESS

Does the burn in the elderly develop worse?

Within Virginia Henderson needs there is a section to maintain personal hygiene and skin integrity. We check the integrity of the skin, and in the case of a burn it should be reflected in the nursing attention process. The data that we value must be written down in the patient's medical history. Such as, product type that caused the burn.

In elderly people, cell regeneration is slower making it more difficult to heal burns. So it is true that in the elderly the evolution of burns develops more slowly, and there are pathologies associated such as diabetes that may not heal well.

Therefore the nutritional needs have to be increased. There must be an adequate supply of nutrients and proteins. Thanks to this we will help to reduce septic morbidity for sepsis, and the length of hospital stays will decrease.

http://www.bibliotecacochrane.com/BCPGetDocument.asp?SessionID=%206835650&DocumentID=CD005489

COMPREHENSIVE GERIATRIC ASSESSMENT

PSYSICAL EXAMINATION.

FUNCTIONAL EXAMINATION.

COGNITIVE ASSESSMENT.

SOCIAL AND AFFECTIVE ASSESSMENT

Comprehensive geriatric assessment in geriatric patients is the key tool that evaluates the physical, mental, social and functional area.

In this assessment we collect the most important health problems in the elderly and we review the medications they take daily.

We will perform health promotion and prevention activities.

We will value the functional area, which is the process that is aimed to collect information about the ability of the elderly to maintain their independence and practice their habitual activity.

In this area one of the scales that we will use is the Katz index that appreciates the daily living activities.

It is a qualitative scale consists of 6 items.

1. bath
2. Dressing / undressing
3. the toilet use
4. mobility
5. continence
6. food

A study was made in which they wanted to know the functional capacity of elderly patients by Katz index and know the reliability of this index in the primary care setting.

It was performed in Oviedo, it was a descriptive cross-sectional study with patients older than 65 years, health center users from Otero. There, the elderly population is 12, 86% of the population that goes to the center.

The key findings related to the Katz index say that it is a method for assessing the functional capacity of the elderly reliably in the primary care environment and it can be used by any professional in the team.

As noted disadvantage of this index it is not sensitive to minor changes.

Moreover we will assess the clinical area. Within this area we will make the anamnesis, which include:

• A personal history.
• Review of equipment and systems to the needs of Virginia Henderson.
• Complete drug history.
• Nutritional history.

In this last section we can include nutritional evaluation by Mini Nutritional Assessment (MNA).

This test is valued with a maximum of 30 points: <17 points indicates poor nutritional status, 17 to 23.5 risk of malnutrition and if the score is higher than 24 means a good health.

THEORIES OF AGING.

There are various theories about aging. They explain what the reason for the physiological changes of aging is. Within biological theories of aging genetic theory exists.

The genetic theory claims that the genetic factor is an important determinant of the aging process.

There are many diseases in which the genetic factor is crucial for the offspring to have the disease. And many diseases like breast cancer, where there is a lot to do with genetics but I think that is not fully demonstrated that it is hereditary.

As I read about this cellular aging theory it will be dependent on the age-progressive loss of genetic material at the ends of chromosomes. When cells reproduce in the organism, the telomere is shortened and the result is cellular aging.

I have read and thought about this theory as it states that exposure to several factors accelerate cellular reproduction and it also accelerates telomere loss. So you have to try not to have overexposure to the sun and radiation, besides avoiding stress and tobacco as they affect in the same way to the body.

As cited above, and more factors accelerate the aging process.

PHYSIOLOGIC CHANGES.

PATHOLOGY COMMON AGING

Within the musculoskeletal changes in aging we have osteoporosis.

Osteoporosis in a systemic skeletal disease characterized by low bone mass and bone disorders. It is a chronic process that is developed with age and it is associated with various diseases and treatments. It is also influenced by heredity, environment and lifestyle.

The bone changes make it have reduced resistance and increased bone fragility.

In the elderly the clinical complications associated with osteoporotic  fracture include increased morbidity, mortality and increase of suffering new fractures.

Are there steps that could make an old woman become old age with fewer fragility fractures related to osteoporosis?

What is clear is that it is very important to try as far as possible avoid osteoporosis helping patients after menopause.

We will have an impact on healthy habits before the patient reaches the age to try to prevent fragility fractures.

These measures are:

• Follow a diet rich in calcium and vitamin D. calcium is the main mineral component of bone tissue. Studies have support that an intake of 1000 mg / day of calcium reduces by 12% the risk of hip fracture.
• Regarding  vitamin D it is important in the absorption of calcium, and its deficit is somewhat related to osteoporosis.
• Sun exposure is very important for the synthesis of vitamin D. There is very little evidence on the effect to reduce fragility fracture but knowing that it is important for the synthesis of vitamin D we will recommend it to the patient.
• The consumption of tobacco. Women who smoke have lower levels of urinary estrogen and menopause comes earlier than in nonsmoking women. Bone loss ratio is about two times higher in smokers. And there are studies that confirm that smokers have an increase of fracture at all locations.
• Excessive alcohol consumption increases the risk of fragility fracture. According to a Danish study there is a high association between alcohol intake and hip fracture.
• Excessive consumption of caffeinated drinks increases the risk of fractures. Caffeine interferes with the absorption of calcium. As shown in one study (Moehrer et al 2003) daily caffeine intake is a factor for hip fracture.
• Physical exercise increases bone reabsorption and formation. Studies show that regular exercise practice(compared with sedentary people) have a lower risk of fractures.

We will recommend what was cited above to the menopausal patient to improve their future quality of life. So we can somehow help women to reach better an old age and with less chance of osteoporosis.

http://www.guiasalud.es/GPC/GPC_476_Osteoporosis_AIAQS_compl.pdf

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