Geriatrics for the 3rd millennium

It is a common knowledge that the population around the world is growing old at an unprecedented rate. This is the success story of increasing life expectancy. The demographic breakthroughs occurred in the 20th century. The quality of life breakthrough is our challenge for the 21st century. The implications of the growing elderly population are many, including: rising total health care expenditures; the increasing needs for long-term care services; and the need for expert and focused health care services. Since health care costs increase with advancing age of populations, these costs will fall on older persons, families, and society generally. There is real value for everyone in meeting the needs of an aging society, especially if seen as part of a social contract. The ability to live independently improves with access to good care, but decreases dramatically for those with age-related disabling conditions. With the decreasing number of informal caregivers around the world, frail elderly will require more formal long-term care services. However, due to inadequate attention given to long-term care issues, numerous developed countries have recently started to struggle to develop long-term care service programs that will both meet the rising needs for this service and be cost-effective. Effective medical care requires expertise in functional assessment, interdisciplinary care, and advances in treating symptoms of aging. The field of geriatrics is essential to modern health care, and geriatricians need to have proper training that focuses diagnosing and treating this group of patients. Quality care will not only help the elderly to live productively and independently, but it will also tremendously benefit families and communities.     

Preparing the older adult for surgery and anesthesia.

Life expectancy in the United States has increased significantly over the past 100 years. It has been suggested that by the year 2050, approximately 20% of the population may be over the age of 65. Many of these older adults will undergo surgery and anesthesia. Preadmission testing nurses need to be able to deal with the various challenges that accompany this group of patients. While many of the elderly are quite active, there are others with multiple disease processes that put them at an increased risk over the general population. It will be to the advantage of all involved if health care providers can develop a better understanding and an increased expertise in caring for the geriatric surgical patient. This article describes the importance of the preanesthetic nursing assessment and evaluation in helping to identify potential problems so that a plan of care to prevent those problems can be formulated and communicated to other members of the health care team.     

The role of palliative care in trauma

Trauma remains a leading cause of morbidity and mortality in the United States. Despite the aggressive and heroic nature of trauma care, including trauma surgery, 10% to 20% of patients admitted to trauma intensive care units die. As the population continues to age, it is predicted that by 2050, approximately 40% of those experiencing traumatic injury will be older than 65 years. For multiple reasons, people in this age group who experience trauma are at greater risk for death. Palliative care is the specialty of health care that provides care for patients with serious, life-threatening, or life-limiting illness or injury, regardless of the stage of disease or treatment. The goal of palliative care is to reduce or alleviate suffering through expert pain and symptom management, as well as assistance with decision making. The integration of palliative and trauma care can assist and support patients and families through stressful, often life-changing times, regardless of the final outcome.     

Perspective in the incidence of Alzheimer's disease in Austria by the year 2050]

Population projections of the Austrian Central Statistical Office show a dramatic increase in the proportion of people of 65 years of age and over in Austria by the year 2050. Since this population group is at higher risk to develop Alzheimer's disease (AD/SDAT), it will be necessary to modify the currently available facilities for social and medical care to meet this increasing demand. Based on official demographic data and epidemiological findings of the "Eurodem" group, our computations show that the number of persons with AD/SDAT aged 65 or over will rise from 48,000 at present to over 113,500 in 2050 (1990: 614/100,000, 2050: 1505/100,000 persons of the total population), equivalent to an increase of 140%. By forecasting the number of persons affected, it should be possible to intensify (and in some areas introduce) long-term health planning with respect to the social, financial and medical care of aged, demented people in Austria.     

The economic costs of a normal life: the case of Dr. Barnardo's Intensive Support Unit

The number of children living in mental handicap hospitals has fallen substantially in recent years, but those who remain tend to be amongst those with the most profound handicaps. If the benefits of community care are to be extended to this group of children then new residential facilities will have to be sufficiently resourced to cater for their special needs. This article reports on the economic costs of one residential unit, the Dr. Barnardo's Intensive Support Unit (ISU) in Croxteth Park, Liverpool, which was established especially to accommodate young children with severe mental handicaps. The costs of care in the ISU are compared to the costs of caring for chidren with similarly high levels of disability in an NHS community unit. Although the ISU is found to be initially more expensive per child than the larger NHS unit it has succeeded in its policy of finding foster homes for its children. This success is not only likely to improve the welfare of the children but will also reduce the long-term costs of their care. The unit has not been in operation long enough to ensure that all the costs of foster care are included. However, after three years, it does seem that ISU-based care may be no more expensive than care in a larger NHS community unit.     

The elderly with AIDS. Case report

When we speak about AIDS, even today, we rarely associate it with the elderly. Nonetheless, nursing care reality demonstrates that AIDS cases are more numerous all the time inside this population group known as the third generation. We should not forget that sex is a personal experience that can be practiced at all ages, and is not limited only to the young, and that preventive measures are necessary in all situations. Therefore, it is interesting to share what these authors reflect about this topic; they refer to a real case. It will probably be necessary to change the established schemes and consider this age group to be one in need of information on the possibilities of contagion. It will also be essential to carry out faster diagnoses and to develop educational measures as well as continuing professional development procedures in order that the elderly be considered susceptible to suffer this disease and to improve the treatment provided to the elderly. AIDS does not discriminate. Therefore, we cannot discriminate either.     

Projections in the incidence of dementia in Austria for the years 1951 to 2050

Because of the increasing life expectancy it is generally assumed that the number of demented individuals will steeply rise in the next decades. Dementia is a main reason for requiring extensive nursing care. Therefore, estimations of the future number of demented subjects in Austria are necessary for planning appropriate services. Since the age structure of the Austrian population has already changed during the last decades, the development of the number of demented individuals during the last five decades is compared with the estimations for the next five decades. These estimations are based on the population projections for Austria and on all available international meta-analyses of prevalence and incidence surveys. Estimations of the number of people suffering from dementia and of those developing dementia within one year are presented for the period between 1951 and 2050. In 1951, the number of dementia sufferers was 35,500; by 2050 this number will increase to 233,800. At present, 90,500 elderly people with dementia live in Austria. Thus, in the next decades, the number of people suffering from dementia will rise more steeply than the in the past. If the projected life expectancy leads to a prolonged duration of illness the number of dementia sufferers will be markedly higher. On the other hand, the working force will decrease in the next decades. Therefore, while in 1951 there were 120 employable persons per demented person, in 2050 there will be only 17 employable persons per demented person. Extensive planning of the future care of demented people is an urgent necessity.     

Abilities and activities of patients with dementia in day hospitals

The proportion of individuals with dementia is increasing in all kinds of institutions. Specialised day hospitals are now being developed as an alternative to long term care for the demented. Twelve day hospital wards, with 312 individuals suffering from dementia, were included in a study aiming to assess functional abilities and frequencies of participation in different activities. Eighty-nine per cent of the day hospital patients could be classified as having a dementia disease. Seventy-eight per cent of the population were dependent on some kind of help from a caregiver in the performance of ADL activities. The most common occupations that could be seen in the programmes were physical activities, entertainment, and personal care activities. The activities were often undertaken as large group activities, often including more than ten patients. The functional abilities that characterise the population are comparable with those of the population living in pensioners' service blocks with full board.     

Rehabilitation needs in the 1990s. Effects of an aging population

The number of physically disabled persons has risen in the past few decades. Acute rehabilitation will continue to increase in importance as a result of the disease and age structure of the population, as well as current hospital reimbursement practices. This project quantifies the continued rise to be expected into the 1990s on the basis of increasing age of the population, using census and hospital discharge data for the state of Rhode Island, which has a population of almost 1 million and is well suited to demographic studies. Although Rhode Island's population is expected to increase by only 3% between 1980 and 1990, a 20% increase is expected for persons over age 65. Age-specific national disability rates applied to these projections show an increase of 7% in persons with activity limitations, with those over age 65 constituting 58% of those with limitations. The most severely disabled, those requiring inpatient rehabilitation, are increasing even more. Estimates of inpatient rehabilitation for the recently disabled person show an increase of 15% by methods developed here based on acute hospitalization data.     

The Neuman System Model applied to mental health nursing of older adults

As we move into the 21st century, nurses are facing the challenge of contributing to the health care of a society with an increasing proportion of ageing persons. This group of people become more heterogeneous as they age, bringing with them an extended life history of experiences of wellness and illness. They have been faced with numerous stressors and losses and have made successful or unsuccessful adaptation to those life experiences. One of the disconcerting stressors of the elderly is the promotion and maintenance of mental health. In this paper we will examine the application of the Neuman System Model to the mental health nursing of older adults.     

The physiologic changes of aging.

It is estimated that by the year 2030, 21.2% of the United States population will be 65 years of age or older. The elderly are the fastest growing segment of the population and use health care services extensively. Today 30% of all hospitalized individuals are elderly. The professional nurse must therefore be able to assess and assist elderly persons during the course of hospitalization. An important component of assessment is the ability to differentiate the normal physiologic changes of aging from the pathologic changes. To effectively intervene in a therapeutic plan of care the nursing professional must be aware of the limitations brought on by aging.     

The coming of age of a joint elderly medicine-psychiatric ward: 18 years' experience

INTRODUCTION: There is a large population of elderly medical inpatients with co-existent medical and mental health disorders who pose a significant management challenge for medical, nursing and allied staff. Our hospital has a joint elderly medicine-psychiatry unit to cater for this patient group; this article reviews how this unit was set up and presents a representative sample of inpatients. RESULTS: The mean age was 81 years with a female preponderance. The mean length of stay was 44 days. The commonest medical conditions were cerebrovascular disease, urinary tract infections, chest infections and falls. The commonest mental health diagnoses were cognitive impairment, delirium and depression. The mortality rate was 21%; of the remainder, 55% were discharged to long-term care, 40% returned home and 5% were transferred to the local psychiatric hospital. DISCUSSION: This cohort of elderly patients has complex medical, nursing and therapy needs in addition to complex discharge planning needs. Our unit has a shared care approach, with joint responsibility shared by a consultant in Medicine for the Elderly and a Consultant in Old Age Psychiatry. This, in combination with a multidisciplinary team approach, provides an effective means of delivering care to this patient group. CONCLUSION: A joint elderly medicine-old age psychiatry ward provides a high standard of care for elderly patients with co-existent physical and mental health needs. We hope that the information presented in this article will be of use to those hoping to set up a similar unit in their own hospitals.     

Caring for the Caregivers: The Hidden Victims of Illness and Disability

As advances in medical care extend the life expectancy of the elderly as well as those with disabling and chronic conditions, new sets of problems often emerge. One such problem is the constantly growing population of those providing care for spouses who, due to a disability, chronic illness, medical condition, or simply the frailty of old age, can no longer totally care for themselves. Well spouses who provide care are at risk for numerous physical, mental, emotional, social, and financial problems of their own. The literature points to several issues that emerge from the caregiving experience, as well as appropriate and effective responses to these issues. Nurses are in a position to identify at-risk caregivers and to advise them of their increased risk of physical and emotional problems. Addressing caregivers' needs helps to ensure that better care will be given to those dealing with or recovering from chronic illness, disability, or medical condition and, thus, that there will be improved results.     

Caring for the elderly: changing perceptions and attitudes.

The aging population is currently one of the main issues facing international health care systems. It is a recognized fact that with advancing age, the likelihood of developing health problems and chronic disease will increase and the demand for health care resources will escalate. This will impact hospitals and long-term care facilities. Our young nurses of the future will be faced with the challenging task of caring for this elderly population. A review of the literature revealed that nursing students have a negative attitude toward the elderly. This may be affected by personal beliefs, values, culture, experience, or observations. Their perceived attitudes toward the gerontology field will make it difficult to recruit the nurses required in this area. This article will explore these issues and examine the role of all health care professionals to help change their attitudes and develop a more positive relationship to meet the needs of this unique population.     

Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Scand J Caring Sci; 2011; 25; 185–193
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population. Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years). Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.     

Perianesthesia Respiratory Care of the Bariatric Patient

Our nation's obesity problem has reached epidemic proportions and is only projected to worsen. The morbidly obese patient is at risk for experiencing a multitude of health-related conditions. Morbidly obese patients are presenting for surgery at an increasing rate, especially with the growing popularity of weight-loss surgery. Therefore the perianesthesia nurse has to remain informed of optimal care strategies for this sometimes challenging population. The obese patient presents with distinct respiratory care considerations of which the perianesthesia nurse must be knowledgeable. This review article will specifically focus on the respiratory care of the bariatric patient presenting for surgery.     

Nursing's losses and gains

Overall, I believe that the most senior trust nurses must establish how many elderly patients receive the kind of care I have described. While new ways of working and new developments in practice are important, we must not forget the essential elements of care in our wish to be innovative. In 2005, it takes courage to be a leader in the NHS. But even greater courage will be required by my mother and her family if she is ever admitted to hospital again. Because an ever increasing number of elderly people need care, all those responsible for this vulnerable client group, including policy makers, need to consider carefully how such care can be improved.     

Promoting mental health in older people admitted to hospitals

Mental health problems are common in older people admitted to general hospitals. With an increasing ageing population, admissions will rise and nurses will be expected to manage patients' co-existing mental health problems as well as physical problems. This article explores potential strategies for the management of patients with depression, delirium and dementia. The emphasis is on improving quality of care for this group of vulnerable patients.     

Risk factor pattern for cardiovascular and cerebrovascular disease as observed in the female population of a Swedish community, Str?mstad

In the community of Str?mstad, Sweden, a high mortality from cardiovascular and cerebrovascular diseases was observed in the female population during the 1970s. In 1985 a health survey was offered by the primary health care service to all women aged 45-64 years in order to identify for later intervention those women who had risk factors for these diseases. More than half the women had one or more risk factors as defined in the study, their number increasing with increasing age. Increased triglyceride concentration or abdominal adiposity or both were present in 23%, while 25% were smokers and 22% had arterial hypertension. By identifying persons at risk, prevention can be initiated by primary health care intervention. A high participation rate (86%) indicates that prevention is requested by the population.