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Geriatrics

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The Most Commonly Indicated Drugs to the Elderly Key words: decubiti, emphysema, deconditioning, dementia, muskuloskeletal limitations, senile osteoporosis, diabetes, to perform self-care, activities of daily living, manual handling, proneness to falls, self-sufficiency AGE-RELATED ISSUES Deconditioning Aged persons have decreased strength, endurance and joint mobility. A 70-year-old man has approximately the same strength as a 15-year-old boy, but without the endurance or flexibility. Deconditioning becomes significant when it results in the old person being unableto perform self-care, carry out activities of daily living,or move about safely. The decrease in physical activity and exercise that frequently accompanies aging may be a major influence in the loss of strength and endurance. Benefits of a regular exercise programme can be both physical and psychological. Falls Falling is a feared but common incident for elderly persons. Risk factors can be intrinsic, activity-related, or environmental. Intrinsic factors are medical conditions that impair a person and predispose him or her to fall. Decreased balance, decreased strength, and decreased flexibility are all factors related to risk of falling. Older persons impaired because of a stroke or a lower-limb amputation are also in high risk categories. Acute illness and decreased alertness because of medication are the intrinsic factors that are always important to take into account. Activity-related falls usually occur during routine daily activities. Falls frequently occur when elderly person leans or reaches from a wheelchair and when gets out of bed at night. Finally, environmental factors increase the risk of a fall. Factors such as inadequate lighting, a slippery or rough floor surface, stairs, an inaccessible bathtub, and icy walkways are just a few of the items to be considered in a comprehensive risk assessment. Prevention is always the best intervention. A home assessment by the therapist will allow appropriate placement of grab bars. The gait training is important. Urinary Incontinence Urinary incontinence is a problem frequently encountered by older persons. It may be due to significant medical disease. It can affect an older person’s acceptance in the family and the community. Constipation The cause for this problem is not necessarily ages itself but rather other factors, which include poor diet, inadequate fluid intake, too little physical exercise, and medications. Osteoporosis Fractures secondary to osteoporosis are disabling because of the chronic severe pain caused by vertebral compression fractures and the loss of ability to walk following fracture of the hip. Senile osteoporosis constitutes a serious threat of fractures in women and men over the age of 75. Optimal treatment is prevention. The rehabilitation considerations for osteoporosis are: diet, exercise, physical therapy, orthotics, and endocrines. Dementia Forgetfulness is a characteristic of aging, and fear of senile dementia commonly accompanies growing old. In fact, intellectual functions are relatively well maintained in normal aging. Some older persons may show mental impairment. They are more prone to have adverse drug reactions. When prescribing medication for an old person, it is important to first review drugs already prescribed. A decreased ability to think or concentrate is as characteristic of a major depression as it is of dementia. Older persons with depression typically show physical signs such as loss of appetite, weight loss, apathy, and inability to initiate activity. Of great concern is that are at high risk for suicide. The more common dementias are due to Alzheimer’s disease, a progressive disorder of unclear aetiology. Stroke 8. Traumatic brain injury Age is a factor in predicting outcome following traumatic brain injury. Increased morbidity and a poorer overall functional outcome are reported for injuries occurring after the age of 60. The influence of age is theorized to be due to reduced plasticity of the older nervous system, but it is likely also due to higher incidence of medical complications related to traumatic brain injury in the older age group. Spinal Cord Injury Spinal cord injuries in the older population more often result from falls that from motor vehicles accidents, the major cause in younger persons. Older spinal cord-injured persons are more likely to have medical complications such as pneumonia, gastrointestinal haemorrhage, and pulmonary emboli. Amputation Success in the rehabilitation of an elderly amputee may not be so much related to age as to a number of associated factors. One such factor is level of amputation. The energy requirements for walking with an above-knee prosthesis are significantly higher than for a below-knee amputees. In the evaluation of the geriatric patient for prosthetic fitting, important considerations include visual acuity, upper extremity strength, lower extremity flexion contractures, the health of the other limb, cardiopulmonary disease, and cognitive status. Musculoskeletal Limitations Chronic musculoskeletal problems are common in the elderly. Evidence of osteoarthritis is said to be universal in persons over the age of 65. Decubiti Pressure sores characteristically occur over bony prominences in an elderly person at bed rest or seated in a chair. They develop owing to many factors that impair the metabolism of the tissues, including mechanical, medical, and biochemical factors. Prevention is the most desirable management. In a case of the pressure sores it is necessary to relieve the pains. Protection in bed ranges from frequent changes of position and use of a special pad, foam, and gel. VOCABULARY euthanasiaeuthanasia geriatricsgeriatrie geriatristgeriatr, odborný lékařpro choroby stáří gerontologistgerontolog gerontologygerontologie hospicehospic locomotor systempohybový systém long-term therapydlouhodobá léčba longevitydlouhověkost manual handlingruční zacházení, manipulace meals on

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