UNIT 1: OVERVIEW OF AGING 1.1 INTRODUCTION OF GERIATRIC NURSING. TENDS AND ISUES

1. The sociological profile of over 65 years in Spain.

The age group from 65 years which combine 'older' people with 'retired' people is very heterogeneous regarding their health status, educational level, property, family network, even the appearance.

In Spain lives seven and a half million people over 65 years, 58% are women and 42% men. And this disproportion of women – men is going in crescendo as more advanced age.

One of the factors that determine such needs of over 65 years is the marital status. In rough terms, 60% of people over 65 years are married, almost double to represent situations widowhood, and only 25% live with relatives. A large number of elderly live alone.

The elderly needs by frequency and according to survey are:

- Financial Aid

- Medical or health problems

- Loneliness

- Family rejection

- Marginalization

- Tourist and cultural activities

- Home help

- Residences

2. Objectives in Geriatrics

This age group has a higher incidence of disease, with frequent coincidence of several diseases in the same individual (comorbidity).

· Increased tendency to chronicity of disease.

· Atypical presentation of illness

· Pluripathology

· Functional assessment, cognitive and social

· Increased complexity of evaluation

· Increased prevalence of disability situations.

· Increased use of primary health care.

· Polypharmacy. Increased consumption of drugs.

· Increased hospital bed occupancy.

· Increased need for continuing care.

· Increased use of social resources.

Aging is known to alter the pharmacokinetics and pharmacodynamics and influences the choice, dosage and frequency of administration of many drugs. The drug also may be complicated by the inability of the elderly to buy or obtain drugs or to follow prescribed treatments (Fulton MM, 2005).

The multipathology in the elderly causes higher consumption of drugs and also increases adverse drug reactions (Juurlink DN, 2003).

Studies have shown that up to 90% of the elderly over 65 years ingest one or more drugs, 50% 2 or more drugs and 12% 5 or more. (Junius-Walker U, 2007).

About 12% of elderly patients who are hospitalized due to an adverse reaction to drugs (Beijer HJ, 2002).

Increasing the number of drugs increases the frequency of adverse effects and adherence worsens (Colley CA, 1992).

Therefore, in clinical practice is recommended:

- Analyze prescriptions and self-medication, including herbal and homeopathic remedies, in order to identify potential drug interactions or drug-disease.

- Introducing a new symptom think in side effects.

From the nurse point of view Geriatrics is caring, not curing, to provide comfort and independence. Is not overtreated mild conditions or sub-contract serious conditions. It is rehabilitate, strive to achieve increases in functionality. This family is crucial for patient care.

So, geriatric objectives are:

- The independence of the elderly, preventing the elderly from becoming a social burden in chronical ills.

- Improving the quality of life, rather than prolonging. Adding years and health to life and life to years.

The deterioration of functional capacity is a common phenomenon associated with age.

3. Geriatric nurse:

While Geriatrics is a medical specialty, Gerontology is considered a multidisciplinary specialty, under the specificity of each discipline, aims to integrate the knowledge of the various factors that affect the human aging process to increase understanding of the person aging and improve their living conditions.

So, we can say that there is no unanimity in the name of the specialty, however we observe three trends in the use of the terms:

1. Geriatric Nursing: sole term for specialized care for the elderly.

2. Gerontological Nursing: to designate preventive care and health promotion of aging people. On the other hand, refers to Geriatric Nursing care aimed at elderly sick or institutionalized.

3. Gerontological Nursing: as a single term to designate specialized care for the elderly.

4. Areas of action

There are two areas of action: community and institutional.

Geriatric Care levels:

·        -  Acute Geriatric Units.

·        - Media Stay Geriatric Units.

·        - Geriatric Day Hospital.

-       - Home Care.

For the device to be efficient care for the elderly, must have:

- Performance in the early phase of functional impairment.

- Selection of the target population.

- Comprehensive geriatric assessment of health status and care needs.

- Maintain control hospital the recommendations of the assessment.

- Functional abilities.

- Multidisciplinary approach to the need for care.

- Establish monitoring.

In an aging society, the health care system must be accommodate for the elderly, shall be designed for the elderly. The geriatric team must control their own recommendations in hospitalized patients because it is associated with decrease in institutionalization and mortality.

When the comprehensive geriatric assessment is not accompanied by control over the recommendations, there are no benefits.

5. Aging and fragility

The main distinguishing feature of acute illness in the elderly is their tendency to disability, especially under conditions of fragility. Frailty is a progressive deterioration to accommodate changes due to an alteration of organic functions and homeostatic control mechanisms.

Therefore, for the detection and assessment of frail elderly is necessary to measure the function to anticipate, predict and reliably calibrate the risk of disability, which allows us to identify high-risk individuals.

Frailty criteria:

- Relief: age over 80 years

- Medicine criteria: Chronic problems (stroke, COPD, Parkinson's, AMI, severe hearing loss, falls, presbyopia, osteoarthritis) cognitive mental impairment and / or depression, terminal illness, recent hospitalization in the last 12 months, polypharmacy (more than 3 drugs)

- Social: social isolation, family, widowhood, disability for ADL, unable to go outside, insufficient financial resources. Held in homes or institutions or reject their medical or social situation.

REFERENCES:

- Abellán García A, García Ayala A. "A profile of older people in Spain, 2012. Basic statistical indicators ". Madrid, Senior Portal Reports, No. 131. [Publication date: 1/06/2012]. <http://envejecimiento.csic.es/documentos/documentos/pm-indicadoresbasicos12.pdf>

              
- Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html

- Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at:
http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf