Care of Aging Skin and Mucous Membranes.

I would like to emphasise the importance of this issue, because during my internships in both health center and in the hospital, I saw the large number of patients who needed to undergo skin care.

From my point of view the skin is the largest organ of our body and perhaps one of the least importance we give. Many times when we get injured or receive a hurt, we do not pay much importance as we thought "Bah! It will heal". But in the case of the elderly and people with some form of paralysis (paraplegia, quadriplegia, hemiplegia ...) things change. An injury in these patients can go from acute to chronic. These people have reduced sensitivity so you do not realize the damage that can occur in the skin. By this I mean for example, an elderly disabled who spend much time in one position, the skin being damaged end and it came to produce a pressure ulcer if there are no suitable remedies. 

From the viewpoint nurse, ulcers is a subject that takes a great burden in caring for the elderly, in patients who remain during a long hospital stay or even when they are institutionalized or still at home, often end up developing some degree of skin damage. For all these reasons, to prepare future nurses about the treatment and prevention of ulcers is something of vital importance and that many universities do not consider.

Bibliography

• Hoffmann G. Care of aging Skin and Mucous Membranes. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 266-284. 

Geriatric Syndromes : Constipation.

The prevalence of constipation increases especially after 60años, and is more common in women than in men. Represents a major geriatric syndromes because of its prevalence, its serious complications and their significant impact on the quality of life of elderly. Only 5% of the elderly have fewer than three bowel movements a week.

Constipation can reach producer serious problems, among them are: fecal impaction anal fissure, circulatory disorders, fecal incontinence and urinary retention.

Additionally, this problem not only afflicts the elderly. Many people suffer from constipation mostly due to poor diet and lifestyle. In most cases, the constipation is caused by a lack of dietary fiber, vegetable, fruit etc. and inactivity and lack of exercise. For these reasons constipation, except it is caused by some gastroientestinal or nervous pathology , it's easy to put a solution changing lifestyles.

I think that nursing plays an important role in informing the public about appropriate changes to treat this condition. Although my personal experience on raising public awareness are not too positive.

When I was in the Health Center, elderly patients with diabetes or obese, were very difficult to convincing  about diet and daily exercise at least in order to have controlled their blood glucose levels and weight respectively, but it seemed that they cared enough little. Many of them put the excuse that they were too old to change his life and if they want to eat a sweet then ate it. The problem comes when the damage occurs, because they want to go to the hospital to treat them and cure their disease in two days to be home again. So we must not only inform, we have to raise the elderly that the problem of not following a proper lifestyle can cause many diseases that can leave them disabled for life.

Bibliography

• FMC. Estreñimiento en el anciano. Formación médica continuada en atención primaria. 2011 ; 18:22-42. Available from:  http://www.elsevierinstituciones.com/ei/ctl_servlet?_f=1012&id_articulo=90065700&idinst=16

Geriatric Syndromes : Dementia and Delirium

So far we have been talking about diseases that affect the elderly physically, but what about those that affect the brain. Cognitive impairment and dementia are the issues most important in Public Health in developed countries.

Although it is the most important problem Has it given the importance it should? from my point of view I say categorically that NO.

In general, our society tends to remove seniors who begin to lose cognitive abilities. When an old man starts not fend for himself for a physical or psychological problem we institutionalize him in order to he disturb as less as possible. In addition, we call the doctor in order to give them drugs that make them recover from their condition, the problem is that people do not understand that this exacerbates the problem.

I think the first thing to do is detect in an early way, the beginning of cognitive impairment to put an effective remedy (both pharmacological and non-pharmacological). Promoting independence to perform basic daily activities is critical to not increase the dependency of the elderly. The activities that we will do must aim for the elderly use mental processes to not atrophy and thus delay the onset of dementia. For example: prevent the patient is isolated at home, a proper diet, trying to performs most activities alone (though it cost), encouraging social relations etc.

Many times doctors are determined to extend the life trying those physical problems and put aside the psychological area that often have to be prioritized. A person mentally impotent, for example with a advantage Alzehimer , is much worse than the diseases that could incapacitate an elderly fitness, due to the latter will still be able to understand and comprehend everything that surrounds him.

Bibliography

• Baztán B, Rexach S. Orientación y tratamiento del anciano con demencia. Sistema Nacional de Salud. 2002 ; 26(3):65-76. Available from: http://www.msc.es/biblioPublic/publicaciones/docs/200203-01.pdf

Geriatric Syndromes : Falls and Instability.

Who has not had a grandfather/mother or a elderly acquaintance who has had an accident and has fallen to the ground? We all know that aging produce a deterioration of our bodies: we become more rigid, our agility decreases, osteoporosis occurs in many cases, we see no good etc.

When we are young a fall is not a major problem that any scratch or numbness, but in the case of elderly things change and it is a factor of high morbidity and mortality.

Come to my mind a patient who I was for two months in MAZ Hospital. She was a 67 year old woman with osteoporosis. Someone tried to steal her purse and when that person removed it, she fell to the ground, this woman only broke a shoulder but due to the operation was complicated, she was in the ICU for 4 weeks, but finally came out and stayed on the for 2 months more in the hospital. Fortunately not all the elderly who fall, end up in the ICU, but it is an example of what can lead a fall for an older person.

For all these reasons we must prevent falls, it is the only way to prevent that our health get worse. I would like to mention some things we could do as preventive measures:

1. Avoid slippery floors, uneven or wet.
2. Good lighting
3. Smoothly and orderly environment
4. Immobilizers: as safety restraints in the elderly (abdominal belt, vest holding and fixing sheets). Such mechanisms will be used in specific situations always.
5. Lowering the bed as much as possible.
6. Install handrails in bathrooms, stairways and corridors
7. Using support measures: walkers, canes, crutches for greater base of support.

Bibliography 

• Hoffmann G. Meeting Safety Needs of Older Adults. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 166-169. 

Urinary incontinence in the elderly

For many people, a trip to the bathroom is something they can easily delay. But for people who suffer from urinary incontinence-the involuntary leaking of urine-holding it in isn't an option.

Although incontinence can happen at any age, it is more common in older adults. According to the National Association for Continence, one in five individuals over the age of 40 suffer from overactive bladder or urgency or frequency symptoms. In the nursing home population, at least 50 percent of residents have elderly urinary incontinence. so we can see that the directo cost of urinary incontinence 8€ billion annually) is greater than the cost of breast, cervical, uterine and ovarian cancers combined.

I remember leaving the Health Center to treat those patients who were in nursing homes. If I saw 20 patients, 15 were bedridden and with diapers. It's amazing that occurs many problems of incontinence in older people, especially in women. I have to highlight a comment that said our Clinical Nursing teacher, she claimed that Asian women were least had incontinence problems because in schools and hospitals, women were taught a series of exercises to strengthen the pelvic muscle (Kegel exercises). This demonstrates how culture influences in health status. If we could only raise awareness to undertake a series of exercises would be saving millions of euros in its infancy, operations and drugs.

For that the physician, nurses, nursing assitans, physical therapists, occupational therapists and facility management need to be actively involved in the development, communication, and implementations of hte plan.However, no staff memebers should consider themselves too important to respond to the needs of patients. A succesful plan can improve the seld-esteem of residents and enhance the perceptions of the level of care held by family members and the community.

As we see, again preventing acquires a major role in health, I always say, through prevention, education and change bad lifestyles, we would get to increase life expectancy, we would have a much healthier life and many of the diseases affecting our society today (especially cardiocirculatory) will become extinct.

Bibliography

• Ouslander J. Urinary Incontinence in the Elderly. PMC. 1981 December ; 135(6):482–491. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273322/

• Lily A. Urinary Incontinence in the Elderly. 2004: Available from: http://www.med.upenn.edu/gec/user_documents/UIinelderly_Arya_Geriatrics.pdf

Health education in the geriatric patient

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 it develop. Thus, we can speak of::

• Primary prevention, when we try to prevent the occurrence of injuries and disease acting through risk factors and promoting healthy lifestyles.

• Secondary prevention, which try 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.

In the elderly all types of prevention are important, although most measures will be included among the secondary prevention, having injuries or diseases at an early stage in an attempt to prevent its progression, and between tertiary prevention, tryinh to prevent disabilities and provide recoveries.

Nowadays prevention is relegated to the background in health, most people prefer to go to the doctor to find a remedy to their problems rather than trying to prevent these problems before it happen. For example, many patients before reducing the large amounts of salt on the food, they prefer to go to the doctor and receive a pill for blood pressure. For this reason we must learn good tactics of persuasion and conviction to try that patients change their harmful habits.

Especially in this group, it has been shown that due to communication problems that they present and their many complaints and vague description of symptoms, patients tend to be put aside preventive activities.

The thing is that the information comes to them in a way that they understand and be easy in order to  they can carry out these tasks.

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

Paliative care

According to the website Get Palliative Care:

"Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.

Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment."

From my point of view, in palliative care, the fact of having to break the news to a patient  who has been diagnosed by a disease that is terminal, is the event / situation more difficult to manage within healthcare. Not everyone is qualified for this work, because even something that you can learn it and end up dominating over time, you have to be mentally capable of performing this task. We could say that "this skill is born and made."

Apart from that "innate ability" other elements we should learn are:

• Silence: a tool for information and therapy. It can be hard to respond to a "sometimes I think I wont get better." A silence reaffirms the patient believe that reflection and silence reports. Also, if you do not know what to say in a very emotional situation is better shut up.

• Active listening: we should listen the words of patients because sometimes silence gives more information than verbal expression. In many cases doctors tend to saturate the patient offering solutions. If a patient cries, would better facilitate the expression of emotion.

• Empathy is emotional solidarity "anyone in your place would suffer". An empathetic attitude towards patients gives us especially professional satisfaction and therefore reduce our suffering.

• Assertiveness: not enough to know what to do, the patient must perceive that we are sure of ourselves professionals. Even in situations of uncertainty.

Bibliography

• Ayarra M, Lizarraga S. Bad news and emotional support. Grupo de Comunicación y Salud de Navarra. 2001 ; 2. Available from: http://www.cfnavarra.es/salud/anales/textos/vol24/suple2/suple7a.html

• What Is Palliative Care?. Get Palliative Care. 2012. Available from: http://www.getpalliativecare.org/whatis/

Acute Myocardial Infarction

Acute myocardial infarction (AMI) occurs because heart cells leave (for any reason) to receive enough blood and all its contents (oxygen, nutrients, ions etc..) Finally, if the situation is not reversed quickly, it eventually causes the death of heart cells.

It is clear that age is one of the major factors in the onset of AMI as in Spain, average age of patients hospitalized with acute coronary syndrome is around 69 years, and the patients admitted to coronary care units AMI in 65. Although athletes and young people is also likely to suffer an AMI, numerous studies show that 75% of deaths occur in patients older than 70 years due to both biological changes that occur in old age and by the multiple pathologies that these patients usually present.

Patients who arriving to the emergency room, have a rather alarming symptoms: often restless, pale, sweaty and tachycardic addition, when performing an electrocardiogram (ECG) is clearly displayed this pathology.
The main problem is that the symptoms produced by the IAM it is not usually present when it suddenly starts, since the first stage is asymptomatic. For these reasons, in many cases, when ischemia is very large and irreversible, is required surgical treatment because the drugs are not effective enough.
The recommendations I can mention about this issue is:

• Recognizing the symptoms of AMI to go as fast as possible to the hospital
• Know how to perform basic CPR
• PREVENTION through a healthy lifestyle (diet, sport, eliminate toxic habits ...)
• Try to be as quiet as possible (to reduce tachycardia)

Bibliography

• Bolooki M, Askari A. Acute Myocardial Infarction. Cleveland Clinic. 2011. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/

• Mauro V, Rodriguez M, Charask A et al. Infarto agudo de miocardio en el anciano. ervicio de Cardiologia. Clinica Bazterrica. 2002 March.

Immobility

Immobility is a common presentation of illness in the elderly and is considered one of the major syndromes in geriatrics. It is estimated that after 65 years, 18% of people have problems with mobility without assistance, and from age 75 over half have difficulty leaving the house. 

I think i can say that all young society view the elderly as slow people who have a very passive lifestyle and they used to hinder. I include myself in those people because Who has not had to advance an old man in a hurry? Everyone grow older and the energy that young people have, it is going to decrease litle by litle to the point that if you suffer from a chronic illness, it can leave you  disabled for the rest of your life

Persons who are chronically ill, aged, or disabled are particularly susceptible to the adverse effects of prolonged bed rest, immobilization, and inactivity. After prolonged immobility, there are changes in various organs and systems also tend to perpetuate the syndrome. The most important affected systems are cardiovascular and musculoskeletal.

Immboility impact on the prognosis of the immobilized elderly can be more relevant than the disease itself, may appear even after short periods of bed rest. Some of the problems that the immobility produces are: 

1. Contractures
2. Pressure Ulcers
3. Thromboembolism
4. Dehidration
5. Constipatio
6. Incontinence
7. Hypothermia/Hyperthermia
8. Sleep Disorders or Insomnia
9. Dyspnea 
10. Hypotension

How we can see, the immbility its a serius problem that we must to control this problem in order to prevent any complication.

Basic needs in the elderly: Nutrition Needs

Nutrition plays an important role in health maintenance, rehabilitation, and prevention  and control of disease.  An understanding of the nutritional needs of older adults is essential to providing good nursing care. Good eating habits throught life promote physical wellness and mental well-being and an inadequate nutrition can result in serious problems such as malnutrition which can contribute to the development of osteoporosis and skin ulcers. In addition can complicate existing conditions such as cardiovascular disease and diabetes mellitus

When we talk about nutrition in the elderly, we must show the inadequate supply due to physical changes, for example:

• Reduction in saliva flow and tendency to Dry mouth (xerostomia).
• Thinning and atrophy of the gums, missing teeth, dental replacement.
• Loss of mandibular muscle strength
• Decreased taste buds
• Dysphagia (difficulty swallowing solids or liquids) due to altered swallowing mechanism.
• Less competition sphincter that separates the esophagus from the stomach.
• Less acid secretion and atrophy of the overlying mucosa. They also make slower movements propulsion food into the small and gastric emptying (digestions slow and difficult).

As a result of changes in body composition and generally, the decline in physical activity, older people should take less calories compared to earlier stages of his life; because otherwise, progressively tend to get fat. In addition, due to his unhealthy diet, they used to have nutritional deficit. I have looked at the internet and i have found that many european studies say that vitamin D, B12, folic acid and zinc. 

As far as I´m concerned the nutricion is an importan factor in the health and it is really easy to change. So if we want that the elderly  have a good health we have to start controling him nutrition. 

But How can we control it? In my opinion, we can found many types of  questionnaires but i prefer the "Mini Nutritional Assessment" (MNA). I do not why i prefer this one, maybe is because i think that it is the most complete.  It is s a questionnaire designed specifically to assess the nutritional status of the elderly population about the anthropometric (weight, height ...), general assessment (lifestyle, medication and mobility), dietary assessment and subjective assessment (self-rated health and nutrition).

We can found this questionnaire here: http://www.mna-elderly.com/default.html

Bibliography

• Hoffmann G. Maintaining Fluid Balance and Meeting Nutrition Needs. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 102-130. 

• Estrella M. Nutrición en el anciano. 2012 November 22; Madrid, Spain. Available from: http://www.seen.es/docs/apartados/456/nutricion-anciano2012.pdf

• Morales I. Nutrición en el anciano sano. Clínica Universidad de Navarra. 2011 February 06. Available from: http://www.cun.es/area-salud/salud/nutricion-salud/nutricion-anciano-sano

Pain in the elderly

According to the Medline database PAIN is:

 "An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS".

But thanks to advances in medicine, nowaday this feeling can be defeated, although in the elderly some factors can make more dificult this objective:

1.  Elderly use to be less attended  in the field of health in general due to health is really expensive and resources are limited so research focuses on youth.
2. The cost / benefit ratio is worse in the elderly.
3. Communication problems
4. More time needed

In addition, a lot of people think that elderly trend to complain more than other kind of adults but we can not generalize. During my interships i have found all kind of patient, from patients who go to the emergency for a headache to patients that having a four-stage cancer had not gone to the doctor before. So we have to teach society how to use well the health resources that we have and we should not ignore to patient who complains of pain.

Although we can found many kind of pain, the characteristic of pain in the elderly is that it tends to be chronic. Many studies show that chronic pain its about from 50% in communitary field to 80% in nursing home. It is really easy and cheap give a solution to this kind of pain, even WHO proposed a analgesic staircase limited to a small number of drugs which you can manage pain in 80% of patients in an outpatient.

So, from my point of view and with all this in mind, everybody will be old one day and i suppose that none want to have any kind of pain. For this reason health should not leave out so much the elderly because everybody want to grow old having a good health

Bibliography

• FMC. Dolor crónico en el anciano. Formación médica continuada en atención primaria. 2011 September ; 18:9-23. Available from: http://www.elsevierinstituciones.com/ei/ctl_servlet?_f=1012&id_articulo=90027137&idinst=16

• Ribera J. El dolor en el anciano. Servicio de Geriatría. Hospital Clínico San Carlos. Madrid . 2007 ; 207(4):155-7. Available from: http://www.elsevier.es/sites/default/files/elsevier/pdf/65/65v207n04a13101842pdf001.pdf

Theories of aging

This week we have speak about some theories of aging in class and  i would like to mention two of them particulary. One biologic theorie which is called the programmed theory and one psychosocial theorie which is called the activity theory. 

Programmed theory 

This theory said mainly that mamals are genetically programmed, we have a "biologic clock" that regulates growth and development. So life expectancy is predetermined, with cells programmed to divide a certain number of times. This functional changes in the cells cause aging. 

I am not totally agree with this theory, because maybe is too simply. From my point of view this theory do not consider some important aspects such as might be the life style, the place where her life, the economy, all the diseases that a person can have during all her life and which can reduce the expectance of life etc..

I mean, Do you think that people who have obesity, smoke and drink or they have been a cancer, can live more than people who have a good life style (having a good diet, doing excercise, not having bad habits like smoking or alcohol...)? All this only because her "biologic clock" said  this is the end.  

But on the other hand, i agree in same cases, when a healty elderly dies without any reason, this theory can have the answer saying that her cell numer were finished.

Activity theory     

This theory is one of my favorites because in my opinion, if everyone did moderate exercise and had a proper diet, in other words, if people followed a proper life style, the life expectancy would increase a lot and many of illness that we know (above all cardiovascular diseases) it will greatly reduce. 
The activity theory proposes that activity (mental and physical both) is necessary for successful aging.  An active life helps maintain functioning well into old age so having a "busy life" we reduce the propability of suffer any kind of mental or physical disease like alzehimer. We can find a lot of 

We can find numerous studies that confirm this theory, for example, the study carried out by Buchman AS et al evidence that physical frailty in old age is associated with Alzheimer in older persons. 
In conclusion, if you want to have a healthy life remember, you only have to practice moderate exerecice and eat healthy in order to come up with the best possible health to the old age.

Bibliography 

• Buchman AS, Schneider JA, Leurgans S,et al. Physical frailty in older persons is associated with Alzheimer disease pathology. Neurology. 2008 August 12; 71(7): 499–504. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676981/

• Libertini G. Empirical evidence for various evolutionary hypotheses on species demonstrating increasing mortality with increasing chronological age in the wild. The Scientific World Journal 2008; 8:182-93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18301820

• Nauert PhD, R. Mental, Physical, Social Activity Help Maintain Brain. Psych Central [serial on the Internet] 2012 [Retrieved on April 14, 2013]. Available from: http://psychcentral.com/news/2012/04/30/mental-physical-social-activity-help-maintain-brain/38024.html

• The Cochrane library. [Data base on the Internet]. Oxford: Cochrane editorial-unit; 1999  [updated 2012 May 16; cited 2013 Apr 14]. Physical Activity and exercise for health and well being of older people (Cochrane Review).  Available from: http://www.thecochranelibrary.com/details/collection/2043267/Physical-activity-and-exercise-for-health-and-well-being-of-older-people.html

Global geriatric assessment

On internet you can find many definitions about what is the global geriatric asssesment. 

In short words, it is a complex interdisciplinary diagnostic which allows us to detect the physical, functional, psychological and social problems in the elderly in order to develop an intervention and long-term monitoringof problems. In addition to optimizing resources and getting a better independence.

But the global geriatric asssesment is really big so i am going to divide this point in five:

• Phisical assesment
• Funccional assesment
• Mental and social assesment
• Afective assesment

 Phisical/ clinical assessment

In my opinion is one of the most important because the patient's physical condition will determinate the activities that the pationt is going to be able to do. In addition the phisical problems are easier to treat than mental problems. I mean, heal an ulcer is easier to treat the alzheimer. Although this does not mean that the other reviews are not important. 

A good clinical assessment must consist of:

Anamnesis which appear 

• Personal history,
• Review of systems and symptoms, which leads us to the detection of large geriatric syndromes
• Complete drug history and update in order to detect possible symptoms and signs related to side effects
• Nutritional history

Physical examination: of course we can´t  fully explore all patients but we can teach them about  potential problems that could have and warn us that if it happens. Initial physical examination that if we do as nurses is to observe the physical, personal care, grooming .. and then take vital signs (temerperatura, blood pressure, heart rate and respiratory and oxygen saturation

Laboratory tests:  which, although must send by the doctor, we need to know because if we suspect any disease, we should talk to the doctor in order toasks for the test. Some of them are: hemogram, glucose, electrocardiogram, mantoux thorax x.-ray...

Functional assessment

Is the process responsible for getting information about the ability of the elderly to perform their normal life. But How can we do that? Easy, we only have to use scales. But which is the best scale? well, depens what we want to review. For example, if we have to review how the elderly does the basic activities of daily living we can use:

• Katz Index of independence in activities of daily living
• Barthel Index
• Plutchik's Life Style Index

On the other hand, if we want  to review how the elderly does the instrumental activities of daily living, we can use:

• Lawton and Brody Index

Mental and social assesment

Up till now i have talked about the "physical part" so now is turn to the psychological part which is very important too. I think that helping to treat these patients is the most complicated labor in which you must be really patience. I prefer to help in physical than in mental problems, although I know that both are important. Even if I thought for a moment I would say that the mental part is much more important than physical because what I prefer? -Having a bad appearance but have a good memory and ability to ration or having a good physical appearance but not even remember my name?

Returning to the mental and social assesment, we can divide this in two parts:

• Mental assesment: It is important to pay attention to the cognitive and affective parts, both parties are very fragile in the elderly.

 However, while the elderly are cared for by the family, is still common to find elders with severe cognitive impairment whose family has never detected memory problems. Therefore, regardless of what tell the family and the patient, it is useful to make a small mental examination to reveal any problem at this level. In order to do this, we can turn to some index like: the Short Portable Mental Status Questionnaire of Pfiffer, Mini-mental State Examination of Folstein or cognitive mini-exam of lobo.

• Social assement: allows us to know the relationship between the old man and his environment. although it is a function of the social worker, the nurse should record all relevant data which affecting to the patient.

Afective assesment

In respect of affection, we can mention two psquiatric disorder very common which affect to elderly population are depression and anxiety.

1. Depression: People over age 65 , depressions is a problem for as many as 1% to 9% of community-dwelling eldery, 10% to 26% or more of long-term care residents, and 11% to 46% of hospitalized older adults. But only 1 in 6 elderly who suffer forom depression is teated. Depression may be related to a wide range of factors, including loss of independence or loved ones or increased medical problem. 
2. Anxiety: is an emotional state of discomfort and aprhensión disproportionate to the stimulus that triggers it. In the elderly is more common as a symptom of anxiety as a disease and has repercussions on the life, cognitive performance and worsening depression

In order to appreciate  the affective sphere, we can use a lot of scales but the most important is The Geriatric Depression Scale (Yesavage scale).

Bibliography

• Hoffmann G. Health Assessment of Older Adults. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 151-166. 

• Redin J. Comprehensive geriatric assessment (I). Evaluation of the geriatric patient and the concept of fragility. Servicio de Geriatria del Hospital de Navarra [cited 10 de Apr 2013]. Available from: http://www.cfnavarra.es/salud/anales/textos/vol22/suple1/suple5.html

• Shelkey M, Mason V, Wallace M. Katz Index of Independence in Activities of Daily Living (ADL). The Hartford Institute for Geriatric Nursing. 2012 ; (2):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf

• Barthel D. Barthel Index. University of Dundee. 1999. Available from: http://www.dundee.ac.uk/medther/Stroke/Scales/barthel.htm

• Graf C. The Lawton Instrumental Activities of Daily Living (IADL) Scale. The Hartford Institute for Geriatric Nursing. 2013 ; (23):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_23.pdf

• Pfeiffer E. The short portable mental status questionnaire (SPMSQ). Standfor School of Medicine . 2010. Available from: http://geriatrics.stanford.edu/culturemed/overview/assessment/downloads/spmsq_tool.pdf

• Folstein M, Folstein S, McHugh P. Folstein Mini-Mental State Exam. utmb Health. 1975. Available from: http://www.utmb.edu/psychology/Folstein%20Mini.pdf

• Sherry A A. The Geriatric Depression Scale (GDS). The Hartford Institute for Geriatric Nursing. 2012 ; (4):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf

Speaking with the elderly

Introducction

In the old age there is a development of communication and language, because it extends the general world knowledge and you have more contents and experiences to communicate. But while in normal aging, there are difficulties of lexical access, syntactic processing difficulties and speech organization. This problems seem to be caused by a loss of efficiency in processing.

In addition the physiological changes that occurs hinder the conversation with them. Mainly changes in vision and hearing. If a person can´t look well or he can´t hear very well, the most of sensory signals which are important (warning look in his eyes, the eye contact, body in care), never perceive. But communication problems are not only influenced by phyisiological changes, communication is going to be influenced by society, enviroment, culture, family, loneliness...

With this in mind, if we look at it from the point of view of health, the communication difficulties mean dificulties to establish therapeutic relationships too. From my point of view, the proffesional should work in order to communicate clearly and using other sensory channels to communicate clearly and effectively

Some tips that come to mind that we can do to improve communication are:

• Doing shorts and frequently interviews 
• Being near to the elderly and speaking loudly and slowly 
• Giving him time to respond
• Subsequently request information to the family or primary caregiver to complete and contrast information

Here are two videos that I found it quite interesting and funny in which appear more advice

Bibliography

Rabadán O, Pereiro A, Facal D. Comunicación y lenguaje en la vejez. Portal Mayores. 2006 October 23; (67):1-20. Available from: http://www.imsersomayores.csic.es/documentos/documentos/juncos-comunicacion-01.pdf

Martilla R. Características de la comunicación en el anciano. Terapia ocupacional. 2000 September. Available from: http://www.terapia-ocupacional.com/articulos/Caracteristicas-Comunicacion-Anciano.shtml

The aging

According to World Health Organization (WHO) the aging is a "Physiologic procces that begin at conception and causes characteristic changes in the specie during all its life. When we are old, this changes produce a limited adaptability of the organism in relation to its environment. The times at which these changes happen in the differents organs of the same individual or different individuals are not the sames"

In this physiologic procces which is natural, we can observe many normal changes in the body´s physical structure and function during the aging process. In addition there are also changes that indicate the onset of desease or illnes as WHO says. Knowing that, nurses have to know the difference between this physiologic changes and abnormal changes that signify aneed for medical or nursing intervention. Although most older adults experience one or more chronic problems like arthritis, high blood pressure, diabetes mellitus, cencer heart disease etc. 

The five leading causes of death among older adults are:

TOP 5

1	Heart disease
2	Cancer
3	Cardiovascular disease
4	Pneumonia
5	Chronic obstructive pulmonary disease (COPD)

All things considered, we can observe that the costs of health care have increased dramatically in recent years due to life expectancy has increased, of course, there are other elements  that increase the cost but they are not so strinkin. For this reasons, I think that is necessary to change the health care model because it is untenable. From my point of view we should spend more money on prevention activities since ultimately it will be the best solution. There were more healty people and the health will be cheaper. For example if we warn the high blood pressure of a man,   he won´t have to take pills and will not have to spend so much money on drugs.

Bibliography

Definition of an older or elderly person. World Health Organization; 2012. Available in: http://www.who.int/healthinfo/survey/ageingdefnolder/en/

Geriatric Nursing

Geriatric and gerontology

During this blog I am going to talk about geriatric and gerontology but What does it mean?

well, on one hand GERIATRIC, is the medical specialty that deals with the physiology of aging and with the diagnosis and treatmen of diseases affecting the aged. And on the other hand, GERONTOLOGY is the study of all aspects of the aging process which affects ours society in general like health care, education, business... Nowadays, gerontologycal investigation are considered one of the most important in supporting research in different countries.

Therefore geriatric nursing is the nurse specialist who provides service and nursing care for the elderly, being able to teach, supervise, investigate, manage and lead the care for this group in complex situations that also serves as an advisor in every levels of the socio-sanitary system. 

But Why do we need geriatric nursing? 
The increase of the elderly population and the increasing demand for care by this group justify themselves, the importance of geriatric nursing specialty. Besides that, from my point of view, a normal nurse is not really cualificated to care elderly people, is necesary that all nurses who works in nursing homes or even in a Health Care Center, are specialized in geriatric. I think that due to the complexity of nursing elderly care and generally the length thereof, require a level of professional competence (knowledge, attitudes, and specialized skills) that are not covered in the basic training.

The problem that i observe is that this kind of job is not really atractive for nurses in general.   I mean, for example, i love emergencies and i would like to work in ambulance or in a hospital because i consider myself an active person so really working with elderly people sounds me more "boring"or less exciting. I do not know if really it is the problem but i know that we need more people who are interested in geriatric care than in other specialities because life expectancy is increasing so is needed more and more people specialized in this kind of care.

Bibliography

Hoffmann G. Trends and Issues. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 1-27.