GLOBAL GERIATRIC EVALUATION

-   Diagnostic process, dynamic and structured.

-   Detects and quantifies problems, needs and capabilities of the elder in the clinical, functional, mental and social´s areas to development of strategy for interdisciplinary intervention, treatment and long-term monitoring

-   Optimize resources and achieve greater independence

Objetives:

▪ Improve diagnostic accuracy based on a quadruple diagnosis

-        Clinical

-        Functional

-        Mental

-        Social

▪ Uncover previously undiagnosed treatable problems

▪ Establish an appropriate and rational quadruple therapy to the needs of the elderly

▪ Improve functional status and cognitive

▪ Improve the quality of life

▪ Resources to meet patient and familiy and social environment

▪ Reduce mortality

1. PHYSICAL ASSESSMENT CLINIC:

It should include:

-        classical clinical interview

-        examination of major geriatric syndromes

-        pharmacological history

-        nutritional histoy

-        physical examination

-        additional exploration

-        preparation of a list of problems

-        nursing needs

Great geriatric syndromes:

               Immobility

               Skin integrity

               Altered intelligence

               Introversion -à depression

               Instability

               Starvation à malnutrition

               Incontinence

               Iatrogenic à polypharmacy

               Fecal impaction

               Immunodeficiency

               Sensory impairment

               Poverty à Lack of resources

               Infamous à Terminally ill

HISTORY:

Factors that hinder the clinical interview:

-        communication difficulties

-        vague description of symptoms

-        multiple complaints

Also, it should include:

-        personal history

-        review of systems and symptoms

-        complete drug history

-        nutritional history: MNA à Mini Nutritional Assessment

PHYSICAL EXAMINATION

-        constants

-        Skin

-        Head and neck

-        Chest

-        Abdomen

-        Nervous system

-        Peripheral vascular system

-        Exploration musculoskeletal

Laboratory.

               Electrocardiogram

               Chest radiograph

               Mammography

2. FUNCTIONAL ASSESSMENT:

Collect information about the ability of the elderly to perform their daily activity and maintain their independence in the medium in whuch it is.

-        Basic Activities of Daily living:

o       Food

o       Dress

o       Wandering

o       WC

o       Bath

o       Arrangement

o       Transfer

o       Continence

o       Communication

-        Instrumental activities of daily living:

o       Writing

o       Reading

o       Kitchen

o       Cleaning

o       Shopping

o       Washing clothes

o       Climbing stairs

o       Use phone

o       Medication management

o       Managing money

o       Transportation

Scales à Basic activities of daily living:

Index of activities of daily living: KATZ

Barthel Index

Scale disability Red Cross

Plutchik Scale

Scales à Instrumental activities of daily living:

Lawton and Brody index

Personal reflection:

Make a rating of the patient in order to discover and help the problems the patient may have.

To do this, we will have a clinical interview, physical examination, use of scales to help the patient, and whether a patient is dependent or independent.

BIBLIOGRAPHY:

Trigas-FerrinM, Ferrira-Gonzalez L, Mejide-Minguez H. Escalas de valoración funcional en el anciano. Galicia. 2011

THEORIES OF AGING

Biologic theories of aging attempt to explain why the physical changes of aging occur. Researcher try to identify which biologic factors have the greatest influence or longevity.

▪ The programmed theory à biologic clock.

▪ The rut-out-program theory à every person has a limited amount of genetic material that will run out over a time.

▪ The living theory à individuals have a finite numbers of breaths or hearts beat that are used up over a time.

▪ The gen theory

▪ The error theory à that error ribonucleic acid, protein synthesis cause errors to occur in cells in the body, resulting in a progressive decline in biologic function.

▪ The somatic mutations theory

▪ The free radical theory: the free radical theory provides a one explanation for cell damage. Free radicals are unstable molecules produces by the body during the normal metabolism or following exposure to radiation and pollution. These free radicals are suspected to cause damage to the cells, DNA, and the immune system. One free radical named lipofuscin, has been identify to cause a buildup of fatty pigments granules that cause age spots in older adults. Individuals who support theory propose that the number of free radicals can be reduced by te use of antioxidants such as a vitamins A, C and E carotenoids zinc, selenium and phyttochemicals.

▪ The cross line (connective tissue theory): that cell molecules from DNA and connective tissue interact with free radicals to cause bonds that decrease the ability if tissue to replace itself.

▪ The clinker theory

▪ The neuroendocrine theory

▪ The immunologic theory

Psychosocial theories:

Psychosocial theories of aging don’t explain why the physical changes of aging occur; rather the attempt to explain why older adults have different responses to the aging process.

▪ The disengagement theory: was developed to explain why aging persons separate from the mainstream of society.

▪ The activity theory: propose that activity is necessary to successful aging. Active participation in physical ad mental activities helps maintain functioning well into old age.

▪ Life course theories: life-course theories are perhaps the theory best known to nursing. These theories trace personality and personal adjustment throughout a person´s life. Many of these theories are specific in identifying life oriented task for the aging person. Four of the most of common theories:

-   Erikson`s

-   Havighurst´s

-   Newman´s

-   Jung´s

Implications for nursing:

Nursing can help individuals achieve the longest healthiest lives possible, promotin good health, maintenance practices and a healthy environment. Psychosocial theories help explain the variety of behaviours seen in the aging population. Understating all of these theories can help nurse recognize problems and provide nursing interventions. 

Personal reflection:

The geriatric patient will suffer physical and psychological changes constantly.

Report preventive measures to go, or if the disease is already established making techniques that make carrying easier and more affordable.

BIBLIOGRAPHY:

Gloria Hoffmann Wold. Basic Geriatric Nursing. 5th Edition. Elsevier. Biology of aging. Chile. 2009

PHYSIOLOGIC CHANGES

The normal ageing represents the universal biological changes that occur with ahe and ae unaffected by disease and environmental influences.

The process og ageing is strongly influenced by the effects of environmental, lifestyle and disease states that, in turn related to or change with ageing buy are not due to ageing itself.

The ageing: a physiological process that starts at birth and causes characteristical changes to a species during its life cycle. In the last year of life these changes produce a limitation in the adaptability of the organism in relation to its environment.

The ageing:

-        it’s a normal process

-        it ocurrs in all humans beings

-        it starts as soon as we are born

-        it becomes more noticeable in our final years

-        it restricts our adaptability and reaction time

-        it’s not a standardized process

-        it’s different from one species to another. Each species has its own time limit

-        it’s different from one man to another

-        not all organs of a human being get old at same time.

Biologic:

1)     Identify anatomical and phsyciologtical changes.

2)     The epidermis become more fragile à Risk of sking.

Common disorders:

1)     Pressure ulcers: skirinkage in the cushion provides by a subcutaneous tissue along with vascular changes places the older adult at increased risk for pressure ulcers.

2)     Inflammation and infection: Rosacea (dilated superficial blood vessels and small pimples).

3)     Osteoporosis: porus, britlle, fragile bones à breakage

4)     Osteoarthritis

5)     Rheumatoid arthritis: results from an autoinmmune process.

6)     Bursitis: inflammation of bursa, and the surrounding fibrous tissue, can result from excessive stress on a joint or from a localized infection.

7)     Gouty arthritis: inborn error of metabolism that results in elevated levels of uric acid in the body.

Other common disorders (respiratory):

1)     Chronic Obstructive Pulmonary diseade (COPD): asthma, emphysema and chronic bronchitis.

2)     Influenza (Flu)

3)     Pneumonia.

Disorders in hematopoietic and lymphatic system:

The characteristic of blood change somewhat as person ages. Plasma viscosity increases slightly and is most often related to a general decrease in total body fluid.

Disorders in gastrointestinal system:

-        Hiatal hernia

-        Gastritis and ulcers

Disorders in urinary system:

               The kidneys decrease in size. One-third of their efficiency and they lack functional reserve. The number of nephrons decreases.

Personal reflection: 

The aging has got changes as the years go.

We have to understand the patient, explain and report changes that can be suffering.

If the patient has a disease, we must always explain simply.

Help with techniques and give you the information necessary to control the disease.

BIBLIOGRAPHY:

Gloria Hoffmann Wold. Basic Geriatric Nursing. 5th Edition. Elsevier. Biology of aging. Chile. 2009

TRENDS AND ISSUES:

Geriatrics: is the medical speciality that deal with physiology of aging and with the diagnosis and treatment of diseases affecting the aged,

Gerontology: is the study of the all aspects of the aging process, including the clinical, psychologic, economic, and sociologic problems of older alduts of these problems for older adults and society.

Sociological profile in Spain:

It´s depends sex and age; type of coexistence; economic situation and dwelling; needs by elderly.

Geriatric nursing:

-        Assessment

-        Planning

-        Application

-        Care

  ▪ Function:

1)     Welfare: help, study the situation, interpret data, issue diagnosis, assess,

2)     Social: link between aging and population.

3)     Management-administrative: use resources human and physical.

4)     Teaching: help learning.

5)     Researcher.

▪ Aim:

As nurses, we should provide integral attention in any situation.

-        individual attention (prioritize problems, adapted plan)

-        Disease prevention ( chronic treatments, end-of-live care)

-        Role

-        Respect for elderly and family

▪ Different situations of aging:

-        Elderly healthy

-        Elderly sick

-        Elderly high-risk

The elderly needs attention and understanding.

Nurse, we should be patients, and perform active listening.

We must assess the needs.

Personal reflection: 

We should take into account the situation in which this the old

Help conserve or restore the patient's health

We have to take into account individual values ​​and to develop health programs according to the required needs.