Content

CONTENTS

Principles and concepts:

In this subject, the bioethical principles applied to the care of people will be worked on, with special emphasis and focus on the elderly, in accordance with the situation of fragility and vulnerability they often present.

It is intended to work and provide knowledge in relation to healthy, active, non-pathological aging in the first place.

The most frequent alterations of thermoregulation in the elderly are hypothermia, hyperthermia and heat stroke, which appears regularly and leads to a hydroelectrolytic imbalance with serious consequences for the elderly.

Vertigo has a high prevalence and is a frequent cause of consultation. It is a problem that must be carefully evaluated and is described as a spinning sensation that requires evaluation by a specialist, although nursing exploration can guide the clinical diagnosis and at the same time reduce the number of unnecessary interventions.
Syncope is a sudden loss of consciousness, with spontaneous recovery, caused by a decrease in cerebral blood flow, it can also be caused by metabolic alterations such as hypoglycemia. Nursing must develop the necessary skills to be able to carry out a screening and identify the main causes related to the different situations.

The two digestive symptoms that occur with greater incidence in the elderly are constipation and diarrhea, both entities require an examination of food, hygienic and care habits, in order to reduce and avoid the resulting risks such as dehydration, vasovagal pictures, among others.

Immobility is the difficulty or lack of ability of the elderly person to carry out movements due to the deterioration of their motor functions, which prevent them from carrying out activities of daily life, so that their relationship with the environment deteriorates and favors the presence or development of skin lesions such as dependency-related wounds and vascular ulcers. Knowing the etiology of injuries, their identification, classification and treatment is a nursing activity that is included in the measures to determine the degree of quality of care.

A fall can be defined as falling to the floor, suddenly, involuntarily and unsuspected, which may or may not cause a secondary injury, and which is confirmed by the elderly person himself or another person who saw him fall. Its frequency is high among elderly people admitted to care centers, especially among those who suffer from cardiovascular disorders, and who when they fall are usually conscious and oriented. The falls are related to the increase in dependence as a result of the post-fall syndrome, which appears due to people's fear of having new episodes of falls again.

An important element in the falls and accidents of the elderly requires a multi-intervention prevention plan that preserves the physical integrity of the person and at the same time allows the activation of the necessary social resources, such as tele-assistance services, systems home safety equipment such as smoke detectors, lighting systems, programs to maintain physical (strength and balance) and sensory abilities to prevent or reduce falls and accidents.

Neurological disorders are one of the main causes of chronic processes that lead to disability in the elderly. Since a high percentage of neurological processes occur in old age, this situation occurs for several reasons, among which are the changes that the aging process exerts on the central nervous system, which facilitate the appearance or complication of pathological processes , such as dementias and neurodegenerative disorders such as Alzheimer's, among others, or Parkinson's.

Organic brain diseases are classified into acute and chronic. In the first we find acute cerebral syndromes such as stroke, TIA and in the second are all the dementias. The nurse must know the assessment and screening instruments for dementia in order to establish a care plan for the person and their environment that will reduce the impact these processes have on health and quality of life.
Mental health in the elderly must be dealt with from the perspective of the person as a whole, that is to say it must deal with psychosocial aspects of the care of the elderly and what the ideal environment is like.

Cardiovascular diseases are one of the most important causes of morbidity and mortality among the elderly. The most frequent are angina, CHF, IAM, hypertension, peripheral vascular diseases, arteriosclerosis, aneurysms, arrhythmias and valvulopathies. The signs and symptoms in the elderly have an insidious development and are therefore not recognized, neither by the patient nor by the carers.

The respiratory system is the one that maintains the closest contact with all environmental pollutants throughout life, if we add to this the changes of the aging process, all this increases its vulnerability and creates great dependencies in the elderly person The most common respiratory disorders in the elderly are pneumonia, emphysema, tuberculosis and pulmonary thromboembolism (PE), although in the last two years, acute viral infections such as infections by COVID 19, and other acute processes such as Stationary Flu and Avian Flu. Derived from recent infectious events affecting the respiratory system, it is necessary to establish nursing care plans based on preventive interventions, such as the administration of vaccines, education on hygiene and personal and collective protection, as well as establishing strategies for public health in order to identify and act on possible sources of infection.

The health problems of the gastrointestinal system are of three types, ingestion, digestion and elimination. These three functions are necessary and help the development and maintenance of metabolism. The most frequent problems in the elderly are xerostomia, hiatus hernia, diverticulitis, hepatic colic, hemorrhoids and anemia related to alterations of the gastrointestinal system.

The changes in the sexuality of elderly people begin slowly between the ages of 30 and 40 to become evident as the person gets older, these changes are related to physiological changes in the genitourinary system and generate changes in the relationships of couple

The peak age at which diabetes mellitus is diagnosed in the elderly is between 60 and 70 years. Poor metabolic control generates a series of physiological responses such as sweating, polyuria, tachycardia among others, which are often absent in elderly people.

Osteoporosis is the most prevalent bone disease of a metabolic nature among the elderly and which carries a high morbidity among them, in our country according to data collected from the "Hispanic Osteoporosis Foundation" about three million people suffer from this disease.
It is appropriate to differentiate the concept of fever from hyperthermia, the first is an increase in body temperature, due to the activation of interleukin-1 that stimulates the hypothalamic preoptic area, which is where body temperature is regulated, causing an increase in temperature and the activation of the immune system with the stimulation of neutrophils in the bone marrow, favoring muscle proteolysis. In summary, fever is a defense mechanism of the body as it stimulates the generation of antibodies and acts against antigens sensitive to heat, preventing their development.

Dehydration is one of the important disorders in elderly people, since in the body composition of the body the liquid element constitutes 60% of the body weight, distributed as follows: 40% is in the intracellular space about 28 liters, and the remaining 20% in the extracellular space about 14 liters, a distribution that in elderly people varies, due to changes in the aging process, decreasing total water and increasing the proportion of descending until reaching a percentage that oscillates between 40% and 45%. For this reason, it is also the disorder that occurs more frequently in the elderly, in which several factors are involved that cause a decrease in the contribution of liquids or an increase in the losses thereof. The main one is the lack of sensitivity of the thirst center in elderly people, which, like the temperature regulator, is located in the hypothalamus. That's why in the face of a picture of dehydration, the perceived feeling of thirst is lower, which is why the intake of liquids is not enough, which results in a functional deterioration.

The two types of incontinence that occur in older people are urinary and faecal, the latter with less frequency than urinary, but with a high impact on the quality of life.
Regarding urinary incontinence, the SIC (International Continence Society, 1991) defined urinary incontinence as: The involuntary loss of urine that is objectively demonstrable and constitutes a social and hygienic problem. Urinary incontinence is not a normal process of aging, on the contrary it is caused by some type of functional or pathological disorder. It has very negative repercussions on physical and psychological health. As well as on social activity by limiting it noticeably and of course it has an important impact on health costs.

Faecal incontinence is the inability to control the output of faeces voluntarily, resulting in a change in the normal habits of faecal elimination. With significant alterations in the level of satisfaction of the elderly person's basic needs, similar to what we have described in urinary incontinence, which have repercussions at a bio-psycho-social and economic level, representing an important family burden, the reason why they are often institutionalized

Constipation is the reduction in the frequency of stools that may or may not be accompanied by difficulty in expelling stool. Bearing in mind that normal defecation would be at a weekly frequency that was not less than three times. Other parameters are also involved that would complete this definition such as the consistency of the stool and the presence of symptoms in the evacuation of the stool such as pain and tenesmus.

On the other hand, the demographic changes have caused the different levels of care to start programs to treat and care for the elderly in their environment, in order to minimize the impact of chronic processes and reduce unwanted effects related to health care. The PCC (Chronic Complex Patient) and MACA program has been developed in the last year.
A situation that needs to be worked on throughout the mention is polymedication in elderly people. There is a large number of drugs that can alter the functionality of devices and organs, generating greater dependence and increasing morbidity and mortality. The recognition of the different drugs most common in the field of geriatrics is vital: Indications, dosage, dose, side effects, interactions, and forms of administration.

On the other hand, the need to train future nursing professionals in the assessment of pain in elderly patients with cognitive impairment must be highlighted.
The elderly by age and pathologies have a high prevalence of suffering from sores of different etiologies (venous, arterial, mixed, Martorell), etc. It is essential to recognize the type of sore depending on its etiology, and an appropriate treatment.