11. INMOBILITY

The elderly in his process of aging suffers changes. One of the most important is the lost of mobility. The elderly isn`t a independent person yet. For the elderly is a important change. He can`t have the same.

In the elderly, there are decrease in mobility because they have musculoskeletal, cardiovascular, and respiratory illness.

As Montse queralt, after 65 years, 18% of individuals have problems with mobility without assistance, 50% of those over 75 have problems have trouble leaving home and 20% of them is confined at home.

This decreased mobility or "immobility syndrome" causes decreased muscle and bone mass, disturbed the balance, altered skin integrity by facilitating the development of pressure ulcers and may even favor the loss of cognitive status for lack of stimuli.

The other day, I asked with my grandfather, and he said me that doesn`t have fear of die, and he doesn`t feel sad about losting the mobility because he know his years and he consider that is the normal. I surprised me.

Improved systems are needed to address patient concerns after discharge from the hospital, specifically for patients with mobility impairments_1.

I think that after being in the hospital, mobility is affected. This is a consequence of prolonged bed rest. So many people to go home, have to do rehabilitation, and get used to the routine.

I relate the immobility with the changes in the elderly and with the falls.

If you fall, your body will suffer damage, and damage will affect  the mobility. And with the physical changes occur the same. The physical changes weaken the bones, the muscles, etc, producing fatigue and and less skill in movement.

Bibliography:

1. Dossa A, Bokhour B, Hoenig H. Care transitions from the hospital to home for patients with mobility impairments: patient and family caregiver experiences. Pubmed [Revisado el 27 de abril del 2013]. Disponible en:  http://www.ncbi.nlm.nih.gov/pubmed/23212952

10. PRESSURE ULCER

In this blog post, I will talk about pressure ulcers, because I have seen many ulcers in my stays clinics. And it seems a very common problem in hospitals.

The ulcers for pression are areas of damaged skin caused by staying in one position for too long.₁

Pressure ulcer staging:   http://woundconsultant.com/sitebuilder/staging.pdf

Stage I: epidermis without damage and erythema of skin that it doesn`t dissapear to eliminate the pressure

Stage II: Partial-thickness skin loss including epidermis.

Stage III: Full-thickness skin loss involving subcutaneous tissue. The lession doesn`t affect the fascia.

Stage IV: Full thickness sin loss involving subcatenous tissue, muscle and bone. The lession affects the fascia.

To avoid the risk of pressure ulcers using the Norton scale and braden

http://www.nutrition411.com/wrc/pdf/w0513_norton_presure_sore_risk_assessment_scale_scoring_system.pdf

Another rating system getting more and more popularity is the Braden Scale, created in the USA, more recent  and precise than the Norton scale, which evaluates factors such as sensory perception, skin wetness, nutrition and such.

Pressure ulcers are a variety of treatments.

Depending on the stage of the ulcer, the ulcer tissue, and if there is infection or not, I use some dressings and others.

In my view, the key will not occur this in preventing ulcers.

• Change position at least every 2 hours to relieve pressure.
• Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.
• In the zones with more risk.

• Eat well-balanced meals that contain enough calories to keep you healthy.
• Drink plenty of water (8 to 10 cups) every day.
• Exercise daily, including range-of-motion exercises.
• Keep the skin clean and dry.
• After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin

This is the best treatment for pressure ulcers

Bibliography:

1 Medline. Ulceras por presión. Medline plus.[Revisado el 25 de mayo del 2013] Disponible en: http://www.nlm.nih.gov/medlineplus/spanish/pressuresores.html

2. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008

9. GERIATRICS SINDROMS

The concept of geriatric syndrome is relatively recent, as this terminology was first used in the late 60s. At first, under the name of geriatric syndromes referred to features that had more frequently the elderly hospitalized in Geriatrics, compared to other services₁.

Currently, this term is used to refer to a set of tables, caused by the combination of a number of diseases that reach a large prevalence in the elderly, and are common origin or social functional disability₁.

The major geriatric syndromes, also known as the 4 giants of Geriatrics, include immobility, instability, falls, urinary incontinence and cognitive impairment_1.

The common characteristics are: high frequency, after his appearance all have an impaired quality of life, treatment is adequate, and all are preventable, and finally His diagnostic and therapeutic approach requires comprehensive assessment, interdisciplinary approach and correct use of the levels of care.

In geriatric disease processes, symptoms does not appear clearly as we have seen. However there are a number of recurring symptoms in various diseases, although not known for being itself and / or specifies the population.

In my opinion the pain is a manifestation and a symptom associated with many pathologies, and one of the most typical. Nursing plays a fundamental role. We should know to value and identify.

The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience with actual or potential tissue damage or described in terms of such damage"₂.

The best scale for study to pain is EVA.

There are many types of pain, but they all have one thing in common when you are in pain your body is affected, it is a symptom, not something you can see. qeu I think you lose your appetite, being tired, or not urinating, but the pain affects everything. They take the win, and just feel like you bust. Therefore, we need to know value it, and pay attention. It is the only way to detect and cure.

Bibliography:

1. Gómez. A, Adela. Emilia. Grandes síndromes geriátricos. Elsevier [Revisado en: 7 de mayo del 2013]. Disponible en: http://www.elsevierciencia.com/es/revista/farmacia-profesional-3/articulo/grandes-sindromes-geriatricos-13076255

2. IASP. Pain. Internacional Association for the study of pain. [Revisado el 12 de mayo del 2013]. Disponible en: http://www.iasp.ws/

8. PAE

Since freshman year, we've been doing PAES. We have explained how useful  are and their importance. I think actually, in practice not used, because when you get a patient, follow the steps of the SAP, but you can not write down all the points, because you lose a lot of time.

Have learned it is good to know what to look or have a mindset. But today, everything is computerized.

I also realized that all I've done PAES far have been elderly. Elderly people are more diseases and health problems have, so it is normal that they are going to the doctor more than young people.

I see important having to know all the changes that occur as we age. And also know how to obtain and classify the data we collect in one scan.

When we will finish the race and work in a hospital, 60-70% of people who come, will be greater than 65 years. We have to learn to accommodate them, and be able to find out what happens to help.

      

4-7. GERIATRIC GLOBAL VALUATION

It is a diagnostic dynamic and structures process that it allows to detect and to quantify the problems, needs, and capacities of the elder in the clinical spheres, functional, mental and social, to elaborate stocks on they a strategy to interdiscipline of intervention, treatment and long-term follow-up in order to optimize the resources and of achieving the major degree of independence and quality of life.

This quadruple valuation serves to discover not opposing problems, to improve the functional condition, to improve the quality of life, to establish a treatment also quadruple… etc.

The best means for a correct valuation  is: the anamnesis and the physical exploration

In every sphere a few different scales are used.

I am not going to name all, only that under my point of view I see more important.

In the functional area: Barthel scale and Lawton and Brody. 

URL:  http://fissioterapia.blogspot.com.es/2012/06/el-indice-o-escala-de-barthel.html

Cognitive sphere: Short portable mental status questionaire of pfeiffer, MMSE Folstein, Clock test, and miniexam cognoscitive os Lobo that is the spanish versión of Folstein.

Social Spere: ORS scale and Zarit Scale. And Finally Geriatric depression scale of Yesavage.

It seems very important to the realization of a good review in order to detect problems in the elderly, and put measures to solve them

03. Theories of Aging

There is no single universally accepted definition of aging. Aging is series of changes that occur over time, contribute to loss of function.

Among the theories of aging can differentiate: Biologic theories, and Psychosocial theories.

Biologic theories of aging attempt to explain why the physical changes of aging occur.

Among the biologic theories find the programmed theory, the rut-out-program theory, the living theory, the gen theory, the molecular theories, the error theory, the somatic mutations theory, the free radical theory, the cross line, the clinker theory, the neuroendocrine theory, and  the immunologic theory.

  

Psychosocial theories of aging do not explain why the physical changes of aging occur; rather they attempt to explain why older adults have different responses to the aging process.

Among the psychosocial theories find the disengagement theory, the activity theory, life course theories, life course theories: erikson`s theory, life course theories: havighurt`s theory, and the life course theories: Jung`s theory.

I would like to say that for me, one theory very important is the free radicals theory. One free radical named lipofuscin has been identify to cause a buildup of fatty pigments granules that cause age spots in older adults.

The excessive accumulation of free radicals in the body is purported to cause the psysiologic changes of aging and a variety of diseases.

According Medline Lipofuscin is a brownish pigment left over from the breakdown and absorption of damaged blood cells₁

Lipofuscin is found in heart muscle and smooth muscles and is also called the aging pigment₁

Attached here images of this pigment in cardiac cells:

                         

Bibliography:

1. Kumar V, Abbas AK, Fausto N, Aster JC. Cellular responses to stress and toxic insults: Adaptation, injury, and death. In: Kumar V, Abbas AK, Fausto N, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 1.

2. Hadley EC. The science of the art of geriatric medicine. JAMA. 1995.

02. Physical and Psychological Changes

Old age is a stage that all persons will pass.

People suffer changes lifelong  There are good changes positive steps such as chilhood, hormonal changes such as adolescence, and negative changes as old age.

The integumentary system, which incluyes the skin, hair, and nails, undergoes significant changes with aging. I think that changes in this system are probably the most obvious and are evident to both the aging individual and others, because many of these structures are visible.

Other system that also is affected is the musculoskeletal system. It performs many functions. The bones of the skeleton provide a rigid structure that gives the body its shape. Osteoporosis is a common disorder of aging. It is probably that occur spontaneous fracture of the vertebrae or other bones. This change is relacionated with the mobility of elderly.

Also there are changes in the respiratory system. From 65 years, they start to get flu vaccine.

They have changes in the cardiovascular system, the hematopoietic and lymphatic systems, the gastrointestinal system, the urinary system, the nervous system, the endocrine system and the special senses. In all areas of the body.

I have talked about negative changes, with these changes to realize their potential. The years do experience, responsibility and wisdom. So all isn’t bad.

With the years they have more fanaticism in religious and political ideas. Because they see the changes in their body and they look for things for hold them. These ideas help them.

My grandfather told me many times that he has intelligence but his body doesn`t accompanied him.