Gerontological Care

Claire Welford

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317905509
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

As the world population ages and people live longer, nurses and healthcare workers, no matter what area they work in, will encounter older people. This pocket-sized (120x80mm), spiral-bound guide in the popular Nursing & Health Survival Guide series aims to provide you with the basic but fundamental knowledge you will need to care for older people.

All you need to know on:

• Ageism
• Assessment
• Core gerontology conditions
• Care planning
• End of life care

And much more...

Geriatric giants

Musso and Nuñez (2006) described three entities known as geriatric giants:

• Confusional syndrome

• Incontinence

• Gait disorders.

Some aspects of self-neglect clinically resemble these geriatric giants. These geriatric giants can appear as an acute event or as an exacerbation of an already existing state, often being the only clinical expression of various diseases such as pneumonia, urinary infection, cardiac infarction, etc. Possession of any combination of any two of these can be life-threatening for the older person, as one illness can impact or exacerbate the other.

■ CONFUSIONAL SYNDROME

Normal ageing processes may affect memory by changing the way in which the brain stores information and by making it harder to recall stored information. In addition, some age-related memory illnesses are categorised as confusional syndromes.

Dementia

Dementia refers to a group of cognitive illnesses characterised by a gradual and progressive impairment in memory, intellect, judgement, language and insight and a deterioration in social skills. Dementia is a condition in which there is a gradual loss of brain function; it is a decline in cognitive/intellectual functioning. The main symptoms are usually loss of memory, confusion, problems with speech and understanding, changes in personality and behaviour, and an increased reliance on others for the activities of daily living (Royal College of Psychiatrists).

The most common form of dementia in older people is vascular dementia, which tends to occur secondary to cardiac problems. Vascular dementia refers to a subtle, progressive decline in memory and cognitive functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system. If blood supply is blocked for longer than a few seconds, brain cells can die, causing damage to the cortex of the brain (the area associated with learning, memory and language). Table 4 outlines the differences between vascular dementia and Alzheimer’s disease.

Delirium

Delirium is an acute or sudden onset of mental confusion and rapid changes in brain function as a result of medical, social and/or environmental conditions. Signs of delirium include:

• Changes in cognitive function, e.g. worsened concentration, slow responses, confusion.

• Changes in perception, e.g. visual or auditory hallucinations.

Table 4 Key differences between Alzheimer’s and dementia

SIGNS AND SYMPTOMS	VASCULAR DEMENTIA	ALZHEIMER’S DISEASE
Onset	Sudden	Gradual
Course	Stepwise progression, fluctuating	Gradual steady decline
Focal neurological changes	Present from outset	Develop in later stages
Memory loss	Milder, patchy, difficulty retrieving information	First sign, gradual loss of memory
Gait disorders	Early sign	Middle to late stages
Incontinence	Early sign	Middle to late stages
Personality	Remains intact longer	Gradual erosion
Emotional ability	More emotionally labile	Less emotionally labile
Depression	Common	Less common
Hallucinations and delusions	Common	Sometimes present, especially in later stages
Epileptic seizures	Seizures more likely at any stage	Seizures in later stages
Vascular risk and risk of sudden death	High risk of stroke, even unexpected death	Lower risk of sudden death

• Changes in physical function, e.g. reduced mobility, reduced movement, restlessness, agitation.

• Changes in appetite, and sleep disturbance.

• Changes in social behaviour, e.g. lack of cooperation with reasonable requests, withdrawal, or alterations in communication, mood and/or attitude.

Cognitive impairment

Cognitive impairment is a cognitive decline greater than expected for an individual’s age and educational level. Cognition is the mental acquisition of knowledge through thought, experience and the senses.

Mental capacity is often determined by healthcare professionals through use of the Mini-Mental State Examination (MMSE), Figure 3. Folstein et al. (see p. 56) (1975) developed the Mini-Mental State Examination and stated that it is a brief neuropsychological test for evaluating cognitive status. MMSE scores are affected by age and education level, with lower scores being associated with increasing age and lower educational level. According to Dufouil et al. (2000), the norm for an 85-year-old man is 26 out of 30.

Care

When an older person suffers from a confusional syndrome, the nurse must aim to provide care which is person-centred: respecting the individuality of the person, their unique personality and their life experiences that influence their response to the disease.

The nurse must value the importance of the perspective of the person with dementia and the importance of their relationships and interactions with others.

Orientation to Time

“What is the date?”

Registration

“Listen carefully. I am going to say three words. You say them back after I stop.

Ready? Here they are …

APPLE (pause), PENNY (pause), TABLE (pause). Now repeat those words back to me.” [Repeat up to 5 times, but score only the first trial.]

Naming

“What is this?” [Poi...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• INTRODUCTION
• AGEISM
• NURSING ASSESSMENT FOR THE PHYSIOLOGICAL CHANGES ASSOCIATED WITH AGEING
• NURSING ASSESSMENT FOR ELDER ABUSE
• NURSING ASSESSMENT OF SAFETY
• NURSING ASSESSMENT OF NUTRITIONAL STATUS
• GERIATRIC GIANTS
• OTHER CLINICAL CONCERNS FOR OLDER PEOPLE
• MEDICATIONS AND OLDER PEOPLE
• APPROACHES TO GERONTOLOGICAL CARE
• CARE PLANNING TIPS
• END OF LIFE
• REFERENCES