CARE LEVELS

The pillars on which rests a good care of the elderly are mainly based on interdisciplinary work which should be good coordination between specialized care, health centers, social workers and specialized geriatric care. The correct use of appropriate levels of care and expertise guarantee optimal care for elderly.

Today, we have different levels of care which aims to ensure optimal care to the elderly population. At different levels of care is important comprehensive geriatric assessment on an individual basis depending on the characteristics of each patient and a correct coordination of all disciplines. Levels of Care and Attention are:

Primary care, which deals with the development of prevention and health promotion, curative or rehabilitation. The nurse should work with other professionals involved as social workers, psychologists or therapists.

From my point of view, the work of the nurse is very important in order to perform a comprehensive health education patient and family. Education is very important to explain health-oriented activities such as adequate food, adequate physical exercise, control toxic habits, self-medication, body wash or accident prevention. These activities should be developed in consultation and in home when the patient is not able to access the center. Here is a very important object that is the frail elderly or high risk to develop programs or systematic actions. I also wanted to emphasize that the primary care, is the level of care to the greatest number of elderly can be accessed regardless of the physical, mental and social in which you are.

The general hospital, it is concerned the elderly patient that there is not a geriatric patient and requires input from an ailment. The activities of nursing home hospitalization includes health education, hygiene and mobilization, chest physiotherapy, oxygen, making constant and samples, care, etc. The objective is for the elderly to remain in the community and their environment in the best of health and function as possible, even if they have chronic illness and disability. This service, personally, I think of those who have more benefits for the patient, especially the elderly frail or geriatric patients who can not go to the outpatient clinic.

 

Specialist care is interdisciplinary units to cater specifically to geriatric patients. It may be acute, aimed at geriatric patient admissions for assessment of their pathologies, medium-stay units aimed at functional recovery of medical procedures, surgery or trauma and units for chronic patients or elderly whose residences designed to deterioration of functional capacity leads them to a zero level of independence.

There are also day hospitals that are specialized day care centers in frail patients with physical disability in which rehabilitation once made, go ​​his home. I find it very useful, not only for rehabilitation or physical assistance, also for social help for the elderly, and they relate more, and a way to stay active.

In my view, the specialization in geriatric care is an important support to primary care, as it is carried out, too, teaching programs. Also, I think it is vitally important to the progressive development of specialized geriatric hospital resources, to apply geriatrics from a multidimensional approach. Not forgetting that every time they are most needed, to adapt health system to the progressive aging of society.

 

Bibliography

• Fernández M, Solano JJ. Tratado de geriatría para residentes. Sociedad Española de Geriatría y Gereontología. International Marketing & Communication, S.A. (IM&C). Madrid, 2006

• Bases de la Atención Sanitaria al Anciano. Sociedad Española de Medicina Geriátrica. SEMEG; Madrid, 2001

• Geriatría XXI. Análisis de las necesidades y recursos en la atención a las personas mayores en España. Sociedad Española de Geriatría y Gerontología. Editores Médicos; Madrid, 2000.

HEALTH EDUCATION IN THE GERIATRIC PATIENT

The term health promotion is a group of measures implemented in order to promote an optimal state of physical, mental and social development in the population. This group of measures includes actions in the field of health education, public health policy, disease treatment and preventive measures.

 

Health education is a basic tool in promoting health and preventive action. It is a method of intervention that is also part of the care provided.

The objective of health promotion and health education in nursing, in the elderly population is to maintain the highest degree of autonomy and prevent the onset of disease. It sets a top priority to improve the quality of life, which includes promoting behaviors that favor a style of living. However, in elderly disease prevention has special features. In many cases the disease are already present and perhaps is  more important than the classic goals of reducing mortality and increasing life expectancy, are the goals of preventing and delaying functional decline, avoid dependency and maintain independence and quality of life .

The objectives that a nurse must be marked in preventing geriatric patients are fundamentally maintaining functional independence, improve their quality of life, reduce mortality and increase life expectancy, providing individual attention to the elderly and his environment.

Through health education, nursing the elderly want to get successfully quit living habits that can lead to detrimental impact their quality of life, while replacing them with others that have shown healthier. The health education is essential in this age, having proven effective for improving the quality of life of elderly. This will not only be for the benefit of elderly patients, but also their family and social environment.

Bibliography.

• Wideman M. Geriatric Care Management: Role, Need, and Benefits. Home Healthc Nurse. 2011.

• Pino M., Ricoy M.C., Portela J. Diseño, implementación y evaluación de un programa de educación para la salud con personas mayores. Universidad de Vigo. 2008. Available in: http://www.scielosp.org/pdf/csc/v15n6/a35v15n6.pdf

PALLIATIVE CARE

Palliative care has incorporated a multidisciplinary and interdisciplinary concept in the care of people with advanced disease diagnosis, progressive, incurable and terminal stage. Effective teamwork with different professionals can meet and take care of the various physical, social and spiritual needs of the patient and his family.

Nursing occupies a privileged place it is who remains the most time with the patient, this allows you to clearly exercise the role of caregiver and that is why the nurse should be able to accept that not all patients will heal, which means changing the attitude curative toward an attitude palliative. Therefore, the main goal of nursing is to give the best quality of life for patients and their families. We can say that give relief to suffering is the dominant goal of palliative care. These are based on three pillars: communication, control of symptoms, and family support.

But in my opinion, goes beyond providing direct assistance to physical needs only. Rather the care plans is for the continuity, flexibility, accessibility. The nurse must accompany poise and daily life of patients and their families, and integrate the family into the act of caring. The nurse must support through listening, be sensitive and be aware of the details that give comfort to the patient.

We should note that a dying patient before his death is hopelessly staff, like life. The certainty of death is what humanizes, and of the most important things to consider is that is a living being, and the nearness of death makes to the patient more sensitive, wise and noble. Currently tends to ignore death, the patients that they will die they are separated or they have them asleep, the nurse must procure or allow to the dying  be active before his own death. Not to forget that the patient is still a living person and is entitled to a dignified death.

For me, it is very important in this process the nurse-patient communication as a way to meet the needs of the sick or affected, we must not forget that in many cases the most important tools for providing care are the word and listening, from this monitoring can be made better care.

From my point of view as a project of nurse, in terminal situations the goal of care is not "the cure", is to "take care" to the patient, despite the persistent and irreversible progression of the disease. This is to provide the highest quality of life until death happens.

Bibliography.

• Cruceiro, A. Ética en cuidados paliativos. Madrid: Ed. Tricastela, 2004.

• Collins F. An evaluation of palliative care services in the community. Nursing times. 2004.

URINARY INCONTINENCE IN THE ELDERLY.

Urinary incontinence is defined as "a condition in which there is an involuntary loss of urine through the urethra enough to constitute a social problem / physician." This is a symptom-heterogeneous problem is common in elderly. Their presence in the person produces multiple psychological and social problems because it has been shown that always helps: promote social isolation, mental disorders, skin abrasions or urinary tract infections, and is a common reason for admission to institutions.

In my short experience, I have seen that urinary incontinence is one of the causes of self-marginalization in the elderly. For the person aware of their urinary incontinence, shame, loss of self-esteem and finally, dependence, are unavoidable steps. Even many families are able to care for their elderly until incontinence appears, then seeks to institutionalize the elderly because becomes a major hassle.

Aging itself is not a cause of urinary incontinence, however, some changes associated with age and the highest prevalence of certain diseases predispose to its development.

Urinary incontinence has a negative impact on the elderly who suffers significant impairment in their quality of life, causing multiple repercussions that affect both the physical realm as well as derive important psychic and socioeconomic consequences. It is also associated with perineal erythema, pressure ulcers, urinary tract infections, falls and fractures. I was struck by the fact that currently holds that urinary incontinence may be an early marker of fragility and increased risk of mortality. Multiple studies have also been shown the impact of urinary incontinence in the quality of life, associating also depression and anxiety.

For treatment, a nurse should recommend behavior change habits or perineal rehabilitation, because with these typically get positive results. Here's an important role nursing through standards and education boards, narrow serial controls, help exercises, etc.Only if you have not managed to control urination, is often used to drug therapy and / or surgery.

For all the comment, I think that urinary incontinence is a condition that a nurse must know very well, as it is a widespread problem that will face throughout the career. It is essential to know everything that involves the incontinent patient, including the impact the disease has on the psychosocial field and the quality of life of elderly.

Bibliography.

• Martínez Gallardo et al. Incontinencia urinaria en el adulto mayorRev Med Inst Mex Seguro Soc 2007; 45 (5): 513-521. Available in: http://www.mediagraphic.com/pdfs/imss/im-2007/im075n.pdf

• Engberg S, Kincade J, Thompson D. Future directions for incontinence research with frail elders. Nursing Research. 2004

CONSTIPATION

In my opinion, constipation is generally regarded as a minor problem, even normal. In our society today, is a very common problem, mainly due to lack of exercise and diet. But we must clarify that constipation is a symptom, not a disease.

In the elderly, the importance of the constipation is in the frequency, the problems that this can cause and how it affects the quality of life. The real constipation in this population is difficult to know, because there are not always consulted with the doctor and many more are the elderly that use self-medicating, because half of them take at least occasionally some type of laxative to treat.

With age the intestinal transit is usually slower. Further, the muscular strength is less and reduces the reflection of defecation. Among the causes of constipation can be found:

-          The lack of physical activity and immobility

-          Inappropriate feeding both quantity and quality, by a lack of dietary fiber.

-          Drink few water.

-          Self-medication with laxatives.

-          The side effect of certain medications such as antidepressants, iron, aluminum antacids, diuretics, anticholinergics or opioids, such as codeine

 

The nursing action will be based on several recommendations:

-Increase water consumption.

-Increase the amount of fibre in the daily diet by consuming more fruits, vegetables and legumes or whole grains also.

-Supporting mobility and exercise by walking or abdominal massage in people who are in bed or immobilized.

In addition to the above recommendations, is critical nursing role the patient education, to retrieve the habit of defecating regularly, if possible every day. The nurse should advise the patient to go from 10-15 minutes sitting on the toilet after breakfast, until you feel the urge to defecate, and if the patient does not get it, you must try again after lunch and dinner. The nurse also should teach the patient, the correct position for defecation, with feet elevated, because this position is more physiological and promotes emptying of the rectum.

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. Available in: http://www.medicinageneral.org/revista_58/pdf/603-606.pdf

- Estreñimiento en el anciano.  Form Med Contin Aten Prim. 2011; 18 :22-46. Available in: http://www.elsevier.es/es/revistas/fmc-formacion-medica-continuada-atencion-primaria-45/estre%C3%B1imiento-anciano-90065700-atencion-los-sintomas-frecuentes-anciano-parte-ii-2011

INSTABILITY AND FALL

With the age, the body deteriorates and the primordial functions. The gait instability and falls are common in elderly people, while falls are among the leading causes of morbidity or mortality in this population. The falls are usually an indicator of frailty, and may be predictive of death, and indirect causes (usually through fractures). Nearly a third of people 65 years of age or older living in the home suffer a fall each year, and about one in 40 get in to a hospital.

The Fall Syndrome, due to various intrinsic and extrinsic factors of the patient. Among the intrinsic factors can include: age, acute and chronic diseases, and the use of some drugs. Extrinsic factors encompass architectural barriers and conditions that produce destabilization as the type of shoes or the floor. These factors together with the weakness of the lower limbs and lack of balance, is a risk for the elderly to fall and become disabled thus leading it to be dependent for some time or permanently of another person.

Nursing work is of great importance in various fields:

In primary prevention,  nurse intervention will primarily detect and correct predisposing factors that lead to falls, we will remove carpets at home, obstacles, maintain functional capacity, we exercise programs, avoid toxic habits.

In secondary prevention, initiate measures before a fall. The nurse can apply the Integral Geriatric Assessment. First is discarded loss of consciousness, syncope diseases, ask when and where it fell, what was at the time, how he got up, ask if there have been previous falls, identify gait disturbance, mental confusion…

 

In tertiary prevention, the objective is to reduce the consequences of the fall both physically and psychologically. The nurse should teach the elderly, to restore stability, first sitting and then standing up to reeducate the orthotics and supportive psychotherapy.

I believe that currently, the falls are a major health problem for the elderly and this cause very high costs, as I have seen in my clinic stays. Therefore, prevention is very important, and therefore should improve or adapt practices fall prevention in our country.

Bibliography.

• Millan, J. Inmovilidad, inestabilidad y caídas. En: Geriatria y gerontología. 2010

• Hile ES, Studenski SA. Instability of Geriatrics. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007

ALZHEIMER

The Alzheimer is a degenerative form of dementia characterized by progressive and irreversible deterioration of cognitive functions, which ultimately interferes with the functioning of the patient in daily life.

The patient, over 10-15 years elapsed from diagnosis to end stage, present a progressive disability, loss of independence and a decline in their mental abilities. One of the causes of dementia has been the increased longevity (in Europe, 10% of people over 65 have any signs of dementia, a number that doubles in over 80 years.) Increasing the population old brings an increase in degenerative diseases, highlighting that determine in dementia.

The dementia in general and Alzheimer disease in particular, generate such a wide variety of health problems, both physical and psychological and social, to global patient care and family needs to be addressed by different professionals (GPs, neurologists, psychologists, social workers, lawyers, etc.). I think that within this care team, the nurse has an important weight through programs independent and interdependent care and always in coordination with the other professionals. Alzheimer's patients have a wide range of problems, that in most cases go untreated (the current treatment of Alzheimer's disease has a symptomatic approach and not addressed in any way to the causes of the disease). Nursing as a profession has therapeutic strategies to control, modulate or alleviate many of the problems I mentioned above.

Actually, in the care of patients with Alzheimer-type dementia, is part of a practical justification for the existence of the art and science of nursing with great strength. The Alzheimer's patient will have a number of needs that need to be treated altered, and there are generally no specific drugs or surgical interventions that palliate, but these treat with long-term care. This care will be directed by Nursing to provide comfort to the patient and his family, taking care to add quality to life, care to prevent suffering and pain, and care to live and die with dignity.

Bibliography.

• Alberca R,  López Pousa S. Enfermedad de Alzheimer y otras demencias. Panamericana, Madrid, 2006.

• Roca Santiago, H.M. Lago Bouza, J.R. Millán Calenti, J.C. Gómez Ulla, F. Enfermedad del Alzheimer y degeneración macular asociada a la edad, 2006. Revisado en: http://scielo.isciii.es/scielo.php?pid=S0365-66912006000200006&script=sci_arttext&tlng=pt