IMMOBILITY

The immobility means the loss of autonomy for ambulation, grooming and transfer. That is the decreased ability to perform activities of daily living impairment of motor functions.

Immobility can be: relative or absolute.The risk of relative immobility is bedridden, while in absolute immobility is a risk factor for institutionalization, morbidity and mortality and the appearance Caregiver Syndrome.

Causes of immobility:

• Musculoskeletal: joint degenerative processes, hallux valgus, corns, osteoporosis and  fractures.

•  Neurological Disorders: cerebrovascular disorders, Parkinson's and dementia evolved. This involves pathological gear styles.

•  Cardiovascular Disease: Heart failure, ischemic heart disease, peripheral vascular disorders and chronic respiratory disease.

•  Drugs: Sedatives, hypnotics, antipsychotics, antihypertensives.

• Psychological and environmental factors: depression, fear of falling, architectural barriers ...

Immobility risk factors: Female, sedentary Elderly, frail elderly, relative immobility, Being older than 85 years, Functional disability prior use walker.

The consequences of inaction are severe, so only bed rest should be saved when absolutely necessary, that is when the risk of the activity exceeds the inactivity.

Once the inmobility in the older people is important to star quickly as possible the specific care for the prevention of organ complications, psychological and social, and environmental adaptation of old to minimize the consequences of inmobility.
There are three main sections in the immobility syndrome treatment: general care, rehabilitation or progressive approach to movement and technical aids, and environmental adaptation.

As with any health problem, prevention is better than cure. In this regard, several studies have assessed the prescription of physical exercise and maintaining physical activity as the best way to prevent immobility and decrease the risk of progression to frailty in older people. The benefits of exercise do not decrease with age, still produced an increase in cardiovascular capacity of the muscles (both in volume and in strength) and bone density, decrease anxiety, aggression and depressive symptoms, and favor the socialization. The older person wearing a type of independent living and active with regular exercise conducting statistically has a lower risk of mortality. Seniors who exercise have always age better and have less functional disability, old age is healthier.

Regarding assistive techniques to maintain physical activity when present limitations to perform it, the main ones are: canes, crutches and walkers.

BIBLIOGRAPHY:

Escudero Sánchez, C. Delgado Antolín, J.C. Incidencia y factores predictores de inmovilización crónica en ancianos mayores de 75 años que viven en la Comunidad, 2001. Disponible en:  http://www.elsevier.es/sites/default/files/elseiver/pdf/124/124v36n02a10022132pdf001.pdf 

Morales Obregón, L. Nuñez Rodriguez, L. Riesgos biológicos y psicológicos de inmovilización en pacientes geriátricos. Sistema de información científica, 2004. Disponible en: 
http://redalyc.uaemex.mx/redalyc/pdf/2111/211117850007.pdf 

PRESSURE ULCERS IN THE ELDERLY

Pressure ulcers are areas of damaged skin caused by staying in one position for too long time. Commonly form where bones are closer to the skin, shuch as the ankles, heels and hips.

They are more frequent as age advances, by increased fragility and immobility in older people. Given their frequency of apperance in the geriatric and prognostic significance in this age group, has come regarded as a geriatric syndrome.

It is considered that 95% of pressure ulcers are preventable, using simple techniques such as postural changes and the exquisite care of skin and general condition of the patient. Once appeared ulcer healing can be long and cause significant morbidity, and major expense of health resources.

The most common site of pressure ulcers are the sacrum and the buttocks, heels, elbows, shoulder blades, shoulders and occipital.

They are classified into four grade levels, grade four is the most serius, because it destroys all the tissue to the bone.

As the lesion depth increases, increases healing time.

RISK FACTORS

The main cause of the occurrence of pressure ulcers is the same pressure to cause the closure of capillaries, reducing the supply of oxygen to tissues. However, there are a number of situations or risk factors that increase the likelihood of developing ulcers favorable situation.

The factors that contribute to the production of pressure ulcers can be grouped in this groups:

Pathophysiological

- Skin lesions

- Disorder in the transport of oxygen

- Nutritional deficiencies (default or excess)

- Immune disorders

- Altered state of consciousness

- Motor impairments

- Sensory impairments

Derivatives of treatment:

- Immobility imposed

- Treatments or immunosuppressive drugs

- Sedatives

- Drilling and vascular pathways

Situation:

- Immobility

- By rubbing effect of both clothing and other objects

Derivatives of the environment:

- Lack of health education for caregivers of dependents, infrequent changes of position, wet diaper too long, etc..

- Mattresses and seat cushions are too hard or too soft, easy to crush and become hard.

- Praxis poor by health teams.

All patients who are considered at risk of developing pressure ulcers should have a written care plan personalized prevention and a holistic approach that values ​​both the skin and the nutrition and hydration of the patient.

Regarding the treatment of ulcerative lesion, it must be individualized according to the degree of depth of exudate, presence or absence of infection and location.

CONCLUSION:Approximately up to 95% of pressure ulcers are preventable, so the need for prevention is a top priority, rather than focusing only on the treatment of established ulcers.

BIBLIOGRAPHY:

Baranoski S. Pressure ulcers: A renewerd awareness. 2006; 36(8):36-42

Zamora Sánchez Juan José. Conocimiento y uso de las directrices de prevención y tratamiento de las úlceras por presión en un hospital de agudos. Gerokomos [revista en Internet]. 2006 Jun[citado 2012 Mayo 23]; 17(2): 51-61. Disponible en: 
http://scielo.iscii.es/scielo.php?script=sci_arttext&pid=S1134-928X2006000200006&Ing=es.

PAIN IN THE ELDERLY

Due to advances in treatment, the life expectancy of the population and the proportion of elderly is increasing.The elderly population is, in turn, the age group most drugs consumed, the presence of comorbidity, and chronicity pluriprescripción disease.

The most common diseases in this group of the population are:

• Ischemic
• Oncological diseases
• Infections
• Above all, and most importantly, degenerative diseases

ASSESSMENT OF PAIN

The fundamental problem with the old man when assessing pain, is the needed to sit and listen.

the first thing to assess is evaluate the medical history, background and diseases.

You need a good physical examination and capture whatever is around the pain: 

Signs:

• Tachycardia
• Hypertension
• Sweating
• Hiccup
• Nausea and vomiting
• Anxiety/depression
• Excitation/apathy
• Insomnia

Symptoms:

• Allodynia
• Analgesia
• Anesthesia
• Hyperalgesia
• Paresthesia
• Hyperesthesia

CAUSES OF PAIN

As already said before the pathology prevalent in the geriatric population, the main causes are ischemic pain, infection, and neoplasic diseases, specially degenerative diseases. The other clear cause of pain is by trauma or surgery.

It's important to listen well whens the elderly complain of pain and different scales assesed by the extent of this.

BIBLIOGRAPHY

Álaba, J. Arriola, E. Prevalencia de dolor en pacientes geriátricos institucionalizados, 2009. Disponible en: http://scielo.iscii.es/scielo.php?pid=S1134-80462009000600007&script=sci_arttext

NURSING PROCESS IN GERIATRIC CARE AND GERONTOLOGY

The elderly require a comprehensive and interdisciplinary care include not only cash but also the recovery of their health promotion, and family and individual growth to achieve autonomy.
This is where the nurse should be part of it through their integrity and specific care that performed based on the nursing process.


The nursing process is a rational and systematic planning and provision of care that aims to:

• Identify the patient's health status and problems relating to health care.
• Establishing care plans that meet identified needs.
• Provide specific interventions to meet those needs.

The process of care in geriatric nursing is divided into 5 stages:

1. Assessment
2. Diagnosis
3. Planning
4. Execution
5. Evaluation

It is very important to obtain a comprehensive view of old and active aging to delay dependency and enhance functional capacity and autonomy. Based on an interdisciplinary approach, the objective is proposed to develop a nursing assessment tool, based on the conceptual model of Virginia Henderson and complemented with questionnaires and validated scales to detect the needs of the elderly, weigh the risk of geriatric syndromes and plan appropriate care (geriatric nursing care process).

BIBLIOGRAPHY: 

Vallejo Sánchez J M. et al. Valoración enfermera geriátrica. Un modelo de registro en residencias de ancianos, 2007. Disponible en:http://scielo.isciii.es/scielo.php?pid=S1134-928X2007000200003&script=sci_arttext

Interrelaciones Nanda, Noc y Nic. Elsevier Mosby. Segunda edición. Madrid, 2007

GERIATRIC ASSESSMENT

Geriatric assessment is called the process overall structured, multidisciplinary, which are detected, describe and clarify the multiple physical, functional, psychological and socio-environmental elderly patients presents.

During this process, register the qualities and capabilities of the person, this is dependent valorasi services and finally develops a progressive care plan, ongoing and coordinated targeted to meet the needs of patients and their caregivers.

Thanks to the different questions and test result is obtained gerontological global functional assessment of an elder. This shows the ability or inability of the individual to live independently in the community environment.

Most importantly, from the standpoint of clinical VGI (comprehensive gerontological assessment) is the systematic search for large geriatric syndromes.


Classic geriatric syndromes:

- Immobility
- Falls
- Incontinence
- Cognitive impairment

Geriatric syndromes broadly:

- Pressure sores
- Sensory Deprivation
- Malnutrition
- Dehydration
- Insomnia
- Fecal impaction Constipation
- Depression
- Hypothermia
- Fragility
- iatrogenic

BIBLIOGRAPHY:

Baos V. Estrategias para reducir el riesgo de automedicación. Información Terapéutica del Sistema Nacional de Salud Vol. 24–N.º 6-2000 Disponible en: http://www.msc.es/biblioPublic/publicaciones/docs/200006-2.pdf

San José Laporte A. La valoración de la multimorbilidad en personas de edad avanzada. Un área importante de la valoración geriátrica integral. 2012; 47:47-8

AGING

Aging is integral and natural part of life. The way we age and experience this process, our health and functional capacity, depend not only on our genetic structure, but also (and importantly) what we have done forour lives, the type of things that we have encountered along her, of how and where we have lived our lives. The duration of life is defined as the maximum survivability particular species.Life expectancy, in turn, is defined as the average number of years you live, in practice, from birth or from a particular age.


Despite recent advances, most basic biological mechanisms involved in the aging process remain unknown. What we do know is that:

• Aging is common to all members of any species;
• Aging is progressive
• Aging involves deleterious mechanisms that affect our ability to carry out various functions.

With the aging process, most of the organs undergo a decline in functional capacity and its ability to maintain homeostasis. Aging is a slow but dynamic process dependent on many internal and external influences, and genetic programming included the physical and social environments.Aging is a process that lasts a lifetime. It is multidimensional and

multidirectional, in the sense that there are differences in the pace and direction of change (gains and losses) of the various characteristics of each individual and between individuals.
Each stage of life is important. Therefore, the aging should be viewed from a perspective that encompasses the entire lifetime.

Achieving healthy aging depends on our way of life, so the two interventions are most effective to achieve a healthy diet and exercise.

On the other hand, social relationships are also key to healthy aging and to strengthen the individual physical and mentalemente plus they are directly related to the feeling of well-being and quality of life.

BIBLIOGRAPHY

Consideraciones generales sobre algunas de las teorías del envejecimiento, Universidad de Camagüey, Lic. Gilberto Pardo Andreu Rev Cubana Invest Biomed 2003;22(1)

QUALITY OF LIFE IN OLD AGE

Quality of life is a term that implies a state of feeling of being in the areas of health and socioeconomic psychophysics.

Its aim is to satisfy the needs and demands of the individual in each stage

pa of his life. This implies the existence of two elements:

• Basic human needs, defined as the set of conditions specific deficiencies, recognized by all human beings, who have the means to resolve them.

• Indicators of satisfaction of human needs, which are different measuring elements in each country.

The determination of what is needed and how it affects their lack, varies over time due to changes experienced by mankind. This has been raised fully realized, even in developing countries do not happen to be a theoretical statement, since in fact millions of people are excluded from the minimum conditions of quality of life that is waiting for every human being. It is said that, operationally, the quality of life is context reference. For example, quality of life in childhood, in terminal illness in the elderly, etc.. Man's life is multidimensional and therefore so is their quality of life. Therefore, for evaluation should be taken into account personal factors (health, life satisfaction, independence) and socio-environmental (support networks, social services, etc..).

In short, the quality of life is a subjective-objective assessments of personal and social satisfaction.

Many older people perceive themselves as individuals with a load of experience to offer and wellbeing. They believe that age does not imply a progressive decline or, at least, uncontrollable. This satisfaction with life, however, must be supported by economic and social security, adequate nutrition, a state of relatively good health and family relationships continents. Failing either of these, the perception of well-being both transient and permanent changes. Meanwhile, socioeconomic factors gravitate powerfully in general well-being of the elderly. Low income retirement benefits, or lack thereof, and poor or no social medical coverage, generate different degrees of satisfaction with life altering.

However, it is paradoxical that both socioeconomic excellent and its counterpart, the lack of basic means for a decent living, resulting in a shortened life expectancy. In the first case, a high-fat food intake, that lead to an increase in cardiovascular disease and cancer and, in the second aspect, for lack of nutrients essential for health maintenance.

It is the former that have better living conditions in the year before his death. Also remarkable is the importance of family contention elderly life. Those old who maintain active bonding with your family (married, with children, grandchildren or nephews) live longer than those who lack social and family network. It is observed that the mortality rate is higher among the widowed during the first six months of mourning, then decreasing. Another point to consider is the lesser prestige of the elderly because of modernization. This is due to changes in values​​, education, nuclear family structure, smaller home, etc..

Regarding the independence of the elderly, there is an increase in their tendency to live in an independent household of children while maintaining close contact with them, rejecting possible institutionalization in a nursing home.

BIBLIOGRAPHY

Envejecimiento Saludable. El Envejecimiento y la actividad física en la vida diaria. Organización Mundial de la Salud, 2002.
Disponible en: http://www.imsersomayores.csic.es/documentos/documentos/oms-envejecimiento-02.pdf

Capítulo 9. Envejecimiento y ritmos biológicos. (2011, April 06). Retrieved May 26, 2012, from OCW Universidad de Cantabria. Disponible en: http://ocw.unican.es/ciencias-de-la-salud/biogerontologia/materiales-de-clase-1/capitulo-9.-envejecimiento-y-ritmos-biologicos/capitulo-9.-envejecimiento-y-ritmos-biologicos.

Otero, Puime, A. Relaciones sociales y envejecimiento saludable, 2006. Disponible en: http://econpapers.repec.org/paper/fbbwpaper/201039.htm