PALLIATIVE CARE

The aging of the population and most difficult survival prognosis disease has prompted the authorities to develop specific programs for geriatric care and hospice.

Palliative care and pain treatment are essential to improve or maintain the quality of life of many patients affected by processes incurable, chronic or terminal.
It is necessary to provide palliative care to elderly patients with advanced disease and irreversible. The implementation of palliative care to these patients will present ethical challenges, so the comprehensive geriatric assessment in each case will help resolve the various conflicts.


The purpose of the nurse is:

• Providing the best quality of life for patients and their families.
• Philosophically, getting relief from suffering.

By: communication, control of symptoms and family support.

The Palliative Care Nurse goes beyond providing direct assistance to physical needs only. Rather care plans from the continuity, flexibility and accessibility. What accounts for poise and support in the daily life of patients and their families, also integrating it in the act of caring. Supports from the listener, must be sensitive and are awaiting the details that give comfort to the patient.


The properly care for the patient must be:

• Know and understand, through training and appropriate training and multifaceted.
• Want to do, based on the voluntary and personal qualities.
• Have the opportunity and means: financial, material and human resources.
• The idea of ​​caring often promote him food, hydration, rest.

CONCLUSION

• It is very important nurse caring for the patient.
• Communication is a way to meet the needs of the sick or affected, do not forget that in many cases the most important tools for providing care are the word and listening from this listener can be made better care.
• It is important to the proper conduct of palliative care for terminal ill patient.

BIBLIOGRAPHY


Astudillo Alarcón, W. Albo Diaz, E. Garcia Calleja, JM Palliative care and pain management in international solidarity, 2009. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-80462009000400007&lng=es&nrm=iso

DIFFERENT FORMS OF ASSISTANCE TO THE ELDERLY

Good care for the elderly are mainly based on interdisciplinary work that must be good coordination between specialized care, health centers, social workers and specialized geriatric care.
The correct use of levels of care and expertise guarantee optimal care for elderly.

Unfortunately, there is a saturation of working both in primary care and specialized care and attention prevents hospitals can be done properly.

A primary care, multi-disciplinary work should involve all professional functions they must perform will be aimed at the promotion of health, prevention activities and early detection and treatment of disabling processes.


The work of the nurse is very important in order to perform a comprehensive health education patient and family. Will be assessed:

• Deficiencies at their home
• Lack of resources
• Hygiene
• Detentions
• Constant monitoring
• Cures
• Sampling
• Apply chest physiotherapy techniques 
• Oxygen therapy
• Urinary catheterization

It is very important for health education aimed at explaining a proper diet, adequate physical exercise, control toxic habits, self-medication, body cleansing, prevention of accidents, etc..

The activities of nursing home hospitalization are practically the same, including health education, hygiene and mobilizations.

The specialized care units which include:

• Aimed at geriatric patient admissions for assessment of their pathologies
• Medium-stay units aimed at functional recovery of medical procedures, surgery or trauma
• Inpatient units intended for chronic or nursing homes whose impaired functional capacity leads them to a zero level of independence.
• Acute Treatment Unit (ATU)

There are also day hospitals that are specialized day care centers in frail patients with physical disability in which rehabilitation once again made ​​his home.


CONCLUSION

Fair enough there are additional measures to elder care, since it involves a number of increasingly large population, and need further assessment exhaustive.

But overall prevention.

BIBLIOGRAPHY

Tratado de Geriatría para residentes [Internet]. Madrid: Sociedad Española de Geriatría y Gerontología [acceso 22 de Marzo de 2012]. De Fernández M, Solano JJ. Niveles asistenciales en geriatría. Disponible en: http://www.segg.es/download.asp?file=/tratadogeriatria/PDF/S35-05%2006_I.pdf

HEALTH EDUCATION IN GERIATRIC

We begin by defining two important terms in the world of healthcare:
The 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.



Preventative measures are classified according to the disease stage where they develop. So we can speak of:

• Primary prevention, when we try to prevent the occurrence of injuries and disease through risk factors and promoting healthy lifestyles.
• Secondary prevention, which attempts to detect and treat early asymptomatic disease and existenes although so far.
• Tertiary prevention, which attempts to avoid consequences, relapse, and promote the rehabilitation and recovery of the same.

The goal of health promotion in the elderly population is to maintain the highest degree of autonomy and prevent the onset of disease, ie preservation of health.

NURSING ACTIVITIES

To achieve these goals we have set, we will have an impact on a number of parameters for health promotion:

• Control of blood pressure at least 1 time per year.
• Lipid Control every 5 years to prevent dyslipidemia
• Annual ECG over 75 years to prevent arrhythmias
• Bone Densitometry at 65 years to prevent osteoporosis
• Annual fasting glucose to prevent diabetes mellitus
• Annual review of the mental state by Pfeiffer or MEC to prevent cognitive decline
• Annual review of the state of mind to prevent depressions
• Control of TSH every 5 years to prevent hypothyroidism, especially in women
• Control of vitamin B12 every 5 years to prevent pernicious anemia
• Annual monitoring fecal occult blood to prevent colon cancer screenings making up to 75-80 years in patients with good health
• Mammogram every 1-2 years to prevent breast cancer until 70 years or more if life expectancy is 5 to 10 years
• Pap smear every 3 years to prevent cervical cancer
• Digital rectal exam and PSA test for prostate cancer prevention
• Annual audiometric study to prevent hearing loss
• Study yearly eye to prevent presbyopia, cataracts, glaucoma, diabetic retinopathy and macular degeneration

BIBLIOGRAPHY

González Sánchez, R. Educación para la Salud. Influencia en ancianos hipertensos, 1999. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21251999000400003

URINARY INCONTINENCE

We defined urinary incontinence as the involuntary loss of urine, objectively demonstrable, which causes a social or hygienic problem as it comes at a time and place unsuitable.


It is a dysfunction that occurs in both healthy individuals and patients with persistent, and originates various causes. It is a major health problem because of its connotations often as psychological, social and economic. Although it is associated with a severe prognosis, limited autonomy, self-esteem and reduces significantly impairs the quality of life of those who suffer.
It's a problem more common in women than in men and often clearly increases with age, and this factor most closely associated with urinary incontinence.


TYPES

There are several types of incontinence and the same person may have several to see.
The types of urinary incontinence are:

• Urgency
• Effort (or stress)
• Mixed
• Transitional
• Overflow
• Functional

NURSING ACTIVITIES

As nurses we must conduct a comprehensive evaluation of the needs of each patient, as it is a disease that generates high healthcare spending.

Contents: History, physical and psychological exploration, laboratory tests, diagnosis, plan actions, inform the patient and psychological support this.

NURSING TIPS

• Drinking 2L of fluids a day, being higher intake in the morning than at night, to improve sleep.
• Performing Kegel exercises to improve the muscles and control incontinence.
• Organize urination schedule.
• Analyze what happens or what makes a person go to urinate.
• Organize group exercise classes
• Facilitate access to the bathroom, clothing, home lighting ...
• Promote hygiene
• Notify your doctor at the feeling of fever, chills, lower abdominal pain in the lower back, flank, urgency, change in color, odor, amount of urine, signs of infection.

BIBLIOGRAPHY

Zunzunegui Pastor, M.V. Rodriguez Laso, A. Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años, 2003. Disponible en: http://www.taiss.com/publi/absful/prevalencia%20de%20la%20incontinencia.pdf

DYSPHAGIA

Swallowing is a complex neuromuscular process by which food from the mouth pass through the pharynx and esophagus into the stomach.

Dysphagia is defined by the presence of difficulty swallowing. Data normally is a sign of underlying disease of the esophagus or esophageal neighboring organs, which may be due to gastro-oesophageal reflux, cancer, thytoid disease, stroke and various neurodegenerative diseases such as Alzheimer's, Guillain Barre, Syndrome or Amyotrophic Lateral Sclerosis.
Dysphagia, besides be a risk factor for malnutrition of the patient, in this case, the elderly, can cause complications, some so severe and frequent as aspiration (passage of food into the airwai), where the performance nursing staff and medical practitioners should be fast and efficient, because in a few minutes you can produce the death of the patient.

The nurse assessment at admission and during the stay in the institution it is essential, in addition to being a disease with a high incidence in the elderly.
It´s important the education directed toward these people, or their caregivers which not only has to compose for advice on dietary care but also must be of postural care and training, which can improve the patient's situation in the areas of nutritional, functional, relational, welfare and autonomy.

TREATMENT

The best performing treatment offers these patients, treatment is multidisciplinary, therefore, we treat the pathology from viewpoints of nursing, nutrition, medicine, with the following objetives:

• Getting a good nutritional status
• Reduce aspiration with oral diet
• Reduce other complications associated
• Rate supplements
• Power evaluate other channels, in the case where the oral feeding is contraindicated.

NURSING MEASURES IN PATIENS WITH NUTRITION DYSPHAGIA

• Avoid distractions during feeding
• Upright posture with slight flexion of the neck
• Perform proper cleaning pre and post oral intake
• Start with small amounts. Smell and taste food as it should be adapted to the tastes of the patient
• Give enough time and did not suppress the cough
• Select foods with texture, consistency, flavor and temperatures
• Instruct family and caregives

There are two types of patients for whom these measures are not fully developed:

• Patients with stroke.
• Patients with advanced dementia.

BIBLIOGRAPHY

Ferrero López M. I., Castellano Vela E., Navarro Sanz R.. Usefulness of implementing dysphagia care programme at an intermediate and long stay hospital, Nutr. Hosp. [serial on the Internet]. 2009 Oct [cited 2012 May 23]; 24(5): 588-595. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112009000500011&lng=en

Irles Rocamora J. A., Sánchez-Duque M. J., Valle Galindo P. B. de, Bernal López E., Fernández Palacín A., Almedia González C. et al . A prevalence study of dysphagia and intervention with dietary counselling in nursing home from Seville. Nutr. Hosp. [serial on the Internet]. 2009 Aug [cited 2012 May 23]; 24(4): 498-503. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112009000400016&lng=en

THE FALL IN THE ELDERLY

The aging process is associated with several changes that predispose to falls. Falls are a result of any event that precipitates the patient down against your will. This will occur in the elderly with high morbidity and mortality. The fall is the interaction between risk factors (chronic diseases, impaired balance and gait, drugs, etc..) And exposure to risks or opportunities falling to be taken into consideration together. Also remember that there is an unpredictable or unavoidable fact therefore prevention plays a very important role.


The elderly often accept it as an inevitable part of aging and therefore frequently fail to inquire about this.
The fall of an elder is not an unpredictable or unavoidable due to chance or normal aging individual. In most cases it is a mismatch between the old man and his environment.
The house is where falls happen most frequently, highlighting the bedroom, bathroom and stairs.

FACTORS THAT CAUSE THE FALL IN THE ELDERLY

• Chronic diseases 

• Visual disturbances

• Vestibular System: The loss of age-related balance, can occur as a result of osteoporosis, it can also occur from trauma, ear infections and drug consumption.

• Locomotor system: musculoskeletal disorders associated directly or indirectly with age, and foot problems may be a cause of disturbance of equilibrium and gait, and thus lead to falls.

• Neurological system: Structural changes in the cerebral cortex, either vascular or degenerative disorders of the pyramidal tract, extrapyramidal or cerebellar, are major causes of gait instability.

• Acute Diseases: The infectious, and exarcerbación of some chronic diseases such as congestive heart failure, may precipitate falls.

• Polypharmacy: The 81% of the elderly take their medication and the 2/3 parts over a drug ingested regularly. This figure increases with age, and so 30% of those over 75 years take more than 3 drugs.

• Misuse of drugs: together with the presence of comorbidity, is that advese reactions are more frecuent among the elderly, and therefore increases the risk of falls.

DRUGS THAT CAUSE FALL

1. Benzodiazepines.
2. Antihypertensives: Considered second only to the sedatives, may influence falls or postural hypotension by decreasing cerebral blood flow.
3. Diuretics: For hypotension especially when they are used in cardiac diseases.
4. Phenothiazines: Your reactions are extrapyramidal and parkinsonism. Can you explain some association with falls.
5. Tricyclic antidepressants increases the propensity to fall especially when combined with other drugs that cause postural hypotension, and its main exponent Imipramine. Besides this group caused heart rhythm disorders and anticholinergic effects may be involved in falls among the elderly.
6. Nonsteroidal anti-inflammatory drugs: instability and confusion.

Considering the amount of drugs that cause instability and insecurity in the elderly, we must be wary of imposing treatment where these drugs are combined, because of a potential fall that entails.

In conclusion, in this case is very important the prevention of falls, and they can save a lot of problems for the elderly.

BIBLIOGRAPHY:

Días Grávalos, G. Gil Vázquez, C. Andrade Pereira, V. Alonso Payo, R. Factores asociados con la aparición de caídas en ancianos institucionalizados: un estudio de cohortes, 2009. Revisado en: http://www.elseiver.es/en/node/2080328

André da Silva Gama, Z. Gómez Conesa, A. Sobral Ferreira, M. Epidemiología de caídas en España, 2008. Revisado en: http://scielo.iscii.es/scielo.php?script=sci_arttext&pid=S1135-57272008000100004&Ing=es&nrm=iso&tIng=es

ALZHEIMER

Dementia is the progressive loss of cognitive function due to damage or brain disorders.

Within dementia is Alzheimer's disease, which is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

The Alzheimer's begins slowly. First involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. A related problem, mild cognitive impairment, causes more memory problems than normal for people of the same age. Many, but not all people with mild cognitive impairment will develop Alzheimer's. Over time, in Alzheimer's, symptoms worsen. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later, they may become anxious or aggressive, or wander away from home. Ultimately need total care. This can be very stressful for family members who must care for their care.

It usually begins after age 60. The risk increases as people age. The risk is higher if there are people in the family who had the disease.


The progress of the disease can be faster or slower depending on the environment of the person with Alzheimer's. It's not an easy situation and the family will have to make great efforts to provide the person with Alzheimer most favorable environment possible.

Accelerators disease

- Family Stress
- Sudden changes in daily routines
- Switch to a new, unknown address (such as nursing homes).

Retarders of disease

- Happy family atmosphere
- Exercise
- Socialize with your friends or others

TREATMENT

No treatment can stop the disease. However, some drugs may help prevent a limited time symptoms worse.


There is some evidence that stimulation of the cognitive helps slow the loss of these functions and abilities. This stimulation is to work those areas that still retains the patient so that training to compensate for the losses that the patient is suffering with the disease.
Psychosocial interventions are used in conjunction with drug therapy and are classified as behavior-oriented approaches, emotions, cognitive and stimulation. Research on the effectiveness of these interventions are not yet available and, in fact, rarely are specific to Alzheimer's, focusing on dementia in general



BIBLIOGRAPHY:

Vernooij-Dassen M. Draskovic I. McCleery J. Downs M. Cognitive reframing for carers of people with dementia. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD005318. DOI: 10.1002/14651858.CD005318.pub2. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005318.pub2/abstract

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