Case Study: Common Problems Among Elderly

Aging is a normal progressive process, beginning at conception and ending in death. Aging is not synonymous with diseases but diseases become more common as age progresses. Usually the diseases present with non-specific multiple symptoms that involve many organs. Increasing age in the elderly is associated with the higher morbidity and frequent use of health services. Their illness tends to be chronic with no simple cure. This makes them more dependent on the family, society and health services.

As the population ages, the nurse practitioner will be more involved in geriatric care. There are solutions that nurse practitioners can offer elderly patients to improve day-to-day functioning.

Problems

1. Confusion/Dementia

• Spend time with the Patient
• Use touch to convey concern
• Provide frequent reiteration of orienting data (e.g. time, place)
• Have clocks or calendars in the environment
• Explain all actions, procedures and routines to the patient
• Address the patient by his/her name
• Keep a routine activities

2. Constipation

• Increase Fluid Intake
• Daily Exercise
• Increase fiber intake (e.g. fruits and vegetables)
• Complications associated with constipation include hemorrhoids from straining, anal fissures, rectal prolapse, and fecal impaction. Untreated constipation in institutionalized patients can lead to cemented lesions in the colon, megacolon, bowel blockage and perforation, peritonitis, and sepsis.

3. Osteoporosis

• Have adequate calcium in diet:
• · Milk/dairy products
• · Fish
• · Beans
• · Orange Juice
• · Cereal or read that have added calcium
• · Take calcium supplements
• Get regular exercise
• Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass.
• Avoid large amounts of protein – rich or salty and caffeine foods. They can cause loss of calcium from the body.
• Make the home safe to avoid accidents.
• Practice good posture.
• Use good body mechanics when lifting objects (e.g. bend the knees instead of the back).
• Do back exercises to improve posture.
• Wear rubber-soled, low-heeled shoes that grip well.
• Don’t lift heavy objects.
• Avoid using a stool or bending over.
• Put items frequently used within easy reach.
• Use handrails when going up and down stairs.
• Hormonal Replacement Therapy (HRT) for menopausal women as prescribed.

4. Postural Hypotension (PH)

• Get out of bed slowly and in stages.
• Sleep with head of bed elevated several inches.
• Have a daily fluid intake of 2 to 3 liters.
• Avoid hot showers or baths, may cause venous dilatation thereby, venous pooling.
• Avoid straining at stool. This may cause fall of BP
• Avoid bending down and suddenly standing up again.
• Rest for 60 minutes after meals.
• Avoid hyperventilation. This lowers the BP.
• Exercise regimen must be recommended.
• Use thigh-length elastic stockings to reduce venous pooling.
• Avoid prolonged standing.
• Heed warning signs of PH (e.g., dizziness, faintness, visual disturbances)
• Pharmacotherapy: Fludrocortisone (a mineralocorticoid that promotes retention of water and sodium)

5. Hypertension

• Encourage stress reduction and relaxation.
• Encourage exercise such as swimming and walking.
• Encourage healthy diet (fresh fruits, rice, vegetable).
• No weightlifting.
• Quit smoking, no alcohol,
• Reduce intake of saturated fats.
• Reduce salt intake to 1 to 6 gm per day.
• Take prescribed medications at regular basis.

6. Elder abuse

There are many types of abuse used against the elderly. They include:

• Psychologic abuse such as instilling fear, threatening or making the elderly perform demeaning tasks
• Physical abuse such as hitting, slapping, or burning.
• Financial abuse such as taking their money or forcing them to sign over their assets.
• Neglect such as withholding food, medications or basic care.
• Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions.
• Sexual abuse
• The perpetrator of abuse is usually the spouse or the children of the victim. Caregivers who abuse their elderly family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse.

Source: http://www.medscape.com/

Medical-Surgical Nursing First Ed by Professor Josie Quiambao-Udan, RN, MAN