Care of older adult reviewer - Impaired attention

- Altered level of consciousness

Aging – is the progressive universal decline first in
functional reserve and then in function that occurs in Care of a patient with dementia
organism over time.
 The main goals of care of a patient with
- Aging is heterogeneous dementia to improve cognitive and physical
- Aging is not a disease however, the risk of functioning
developing disease is increased.  Key goal is to identify and treat reversible
causes of cognitive such as:
Common geriatric problems and their management
- Infections
Geriatric syndrome- refers to a symptom presentation - Electrolyte abnormalities
that is common in older adults. - Vitamin deficiencies
- Thyroid disease
- Most are multifactorial in origin - Substance abuse
- Medication
Geriatric giants ( 4 geriatric giants- 4 I)
- Psychiatric illnesses
- Immobility
Falls
- Instability
- Incontinence - Excludes falls occurring from seizure, stroke,
- Intellectual impairment syncope.
- Fall rates and risk of injury from falls increase
Common geriatric problems
with age
- Dementia and delirium - Annually – 30% of community dwelling adults
- Fall >65 years fall
- Urinary incontinence - While 50% of individual 80 years fall
- Pressure ulcers due to immobility - Most falls are multifactorial
- Falling is sometimes a symptom of another
Dementia and delirium disease, such as:
 Infections, neurologic disorder, medication side
 Dementia is a syndrome of progressive decline
effect, and age related physiologic changes
in which multiple intellectual abilities
deteriorate, causing both cognitive and Age related physiologic changes
functional impairment. It is a chronic state of
confusion. - Decreased proprioception
 Delirium is an acute of confusion. It is important - Increased postural sway
to differentiate delirium from dementia. - Declines in baroreflex sensitivity resulting in
 Both dementia and delirium are characterized orthostatic hypotension
by:
Risk factors for falls
- Disorientation
- Memory impairment  Muscle weakness
- Paranoia  History of falls
- Hallucinations  Gait or balance abnormality
- Emotional ability  Use of a walking aid
- Sleep-wake cycle reversal  Visual impairment
 Key features of delirium are:  Arthritis
- Acute onset  Impaired activities of daily living
  Depression
 Cognitive impairment
 Age over 80 years
 Drugs: polypharmacy (4 or more drugs), digoxin,
diuretics, benzodiazepines, phenothiazine,
antidepressants, and type 1 anti-arhythmics.
Urinary incontinence
- UI is a major problem for adults
- Up to age 80 years,UI affects to a women twice
as commonly as men
- After age 80, both sexes are equally affected.
- Leaking of urine or urinary incontinence occurs
in 4 way:
 Stress incontinence
 Urge Incontinence
 Mixed stress and urge incontinence
 Overflow in continence
Stress incontinence- urethral sphincter mechanisms are
inadequate to hold urine during bladder filling rare in
men.
- Leaking small amounts of urine during activities
that increase intraabdominal pressure such as:
 Coughing, laughing, sneezing, lifting or standing
up.
- Stress test can be performed by patient stand
with a full bladder and cough. The positive if
urine leakage coincides with the cough.
- Common in women due to insufficient pelvic
support causes: childbearing, gynecologic
support, decreased effects of estrogen on tissues
of the lower urinary tract
Treatment stress incontinence
 Surgical interventions are the most effective
treatments.
 Pelvic muscle exercises can be helpful
 Treatment failure is higher in patients who have
two or more leakage per day.
Urge incontinence (UI)
 Urge incontinence also known as detrusor
overactivity (DO), characterized by:
- Uninhibited bladder is the most common form
of UI in older adults.
- Urinary frequency and nocturnal incontinence
are common
- Urge incontinence may be: idiophatic, lesions of
the central nervous system, stroke, and bladder
irritation from infection, stones or tumors.
Treatment of UI
- Bladder retraining by encouraging the patient to
void every 2h or based on the PT. symptom
frequency.
- The patient can also try urgency control. If no
incontinence for 2 days, the voiding interval can
be increased by 30-60 minutes until the patient
is only voiding every 3-4h
- The anticholinergic drugs: oxybutynin and
tolterodine
- Patients using tolterodine have a reduced risk of
dry mouth and fewer withdrawals due to side
effects.
Mixed incontinence – refers to UI where symptoms of
both stress and urge incontinence are present.
Overflow incontinence- is due to either bladder outlet
obstruction or an atonic bladder.
- Patients are male but, rarely females
- On physical examination, patients may have a
palpable distended bladder
Overflow Incontinence causes
Male – prostatic hypertrophy
- Prostate cancer
- Urethral structures
Female- cystocele
Causes for both and female
( destrusor atonicity or underactivity can be caused by:)
 Spinal cord disease
 Autonomic disease
 Diabetes
 Alcoholism
  Vitamin b12 deficiency Complication associated with constipation:
 Parkinson’s disease
 Hemorrhoids
 Tabes dorsalis
 Anal fissures
Treatment overflow of incontinence  Rectal prolapse
 Fecal impaction
 Adrenergic blockers:
- Terazosin Postural hypertension (PH) – warning signs of ph
- Doxazosin (dizziness, faintness, visual disturbances)
- Tamulosin
Measure to prevent PH
 5- reductase inhibitor – finasteride
 The diagnosis of functional incontinence 1. Get out of bed slowly and In stages
individual who have UI and have either 2. Sleep w/ head of bed elevated several inches
cognitive or functional impairments which limit 3. Daily fluid intake of 2to 3 liters
their ability to toilet themselves. 4. Avoid hot shower or baths may cause venous
dilatation thereby venous pooling
Pressure ulcers- also known as pressure sores, bedsores
5. Avoid straining at stool. This may cause fall of
or decubitus ulcers, occur in older patients with reduced
BP.
mobility
6. Avoid bending down and suddenly standing up
- A pressure ulcers when increased pressure b/w again.
skin and bony prominence produces tissue 7. Rest for 60min after meals.
necrosis. While pressure ulcers can occur 8. Avoid hyperventilation. This lowers the BP
anywhere. 9. Exercise regimen must be recommended
- 80% of pressure ulcers over the heels, lateral, 10. Use thigh level elastic stockings to reduce
malleoli, sacrum, ischia, and greater venous pooling
trochanters. 11. Avoid prolonged standing.
- Osteomyelitis and sepsis are important, morbid
complications of pressure ulcers.
- Repositioning pt. at risk for developing pressure
every 2hr. (intervention ata in)
- Providing bedbound patients mattresses with
pressure-relieving capabilities are standard
interventions to prevent pressure ulcers.(same
here)

Skin – the skin of elderly bruise easily senile purpura

- Some people skin like transparent tissue paper

described as Paparaceous skin especially back of
the hand and forearm.

Constipation

To prevent constipation

 Increase fluid intake

 Daily exercise
 Increase fiber intake ( fruits and vegetables)