Aging 326

A cerebral degenerative disorder that causes a marked decline in mental functioning that interferes with daily activities and social relationships

A condition that gets worse over time

• *Normal pressure hydrocephalus
• *Intracranial masses
• *Infectious conditions (HIV, neurosyphilis)

• 1.Primary degenerative dementia= Alzheimer's
• 2. Vascular or multi-infarct dementia- r/t blocked vessels
• 3. Parkinson's dementia-problems with balance, movement
• 4. Huntington's Dementia- heredity disease
• 5.Dementias associated with metabolic diseases
• 6. Dementias associated with alcohol or substance abuse

• gradual onset
• slow progressive course
• irreversible

• r/t blocked vessels- associated with hypertension and CV disease
• Dx (diagnosed) by CT scan or MRI
• more abrupt onset- (10-20% of all dementias)
• stepwise progressive course
• potentially reversible- anti platelet therapy

• problems with balance and movement
• affects primarly the lower brain stem so mental capacities may not be affected
• 20-60% develop dementia in late disease if at all

• heredity disease
• Progressive degenerative
• Affects cognition, emotion, and movement
• memory loss, irritability, paranoia, impaired impulse control
• 35-42 year old
• quick jerky movements of face, limbs, and trunk
• dementia in final stage- death usually 15 years after onset

• potentially reversible
• hypothyroidism
• diabetes mellitus
• renal and hepatic dysfunction

• affect cognitive funstioning due to:
• *direct brain damage
• *nutritional deficiencies
• -especially vitamins and minerals

Alzheimer's

inability to speak

inability to carry out purposeful movements

inabiltiy to recognize common objects or faces

• family history
• age
• serious head injury
• cardiovascular disease

• affects one in 10 individuals over 65
• affects nearly half of those over 85
• can strike as early as 30s and 40s

if have a parent of sibling with alzheimers- 2-3 times more likely to develop the disease than those who do not

• Gene identified so far that increases the risk for late-onset AD
• *makes one form of a protein called apolipoprotein E (apoE)
• *everyone has apoE
• *helps carry cholesterol in the blood
• *only about 15% of people have the form of this gene that increases risk of AD

• no. 40 years of research have failed to demonstrate a significant link to aluminum
• silver dental also false
• *because of mercury

• 5.3 million
• number has more than doubled since 1980

11.3- 16 million

6th

• 70% live at home
• 75% of care is provided by family and friends- remainder cost is around 19,000 per year and most of that is paid out of pocket

• 30%
• 50% of all nursing home residents have AD or some type of dementia

cerebral cortex and hippocampus

involves the malfunction or death of nerve cells but why is unknown

• detailed patient history
• info from family and friends
• physical and neurological exams and lab tests
• neuropsychological tests
• imaging tools such as CT scans or MRI- PET scans are used primarily for for research purposes

clumps of protein outside of cells that interfere with synaptic transmission

twisted strands of protein within cells> cell dysfunction and death

as from history of CV disease,stroke(autopsy finding)

on autopsy, alzheimers brain weighs less than non alzheimers brain

degeneration of brain tissuue causes spaces (vacuoles) that become filled with fluid and sand-like particles (granules)

• 8
• may live up to 20 or more

10-20

• 3
• mild,moderate, severe

• entorhinal cortex and proceed to hippocampus
• *affected regions begin to shrink (atrophy) as nerve cells die

memory loss

AD spreads through the brain. The cerebral cortex begins to shrink as more and more neurons stop working and die. Symptoms can include memory loss (forget words and names), confusion,trouble handling money, poor judgement, mood changes, and increased anxiety

• *Increased memory loss, significant confusion, trouble with ADLs, hygiene
• *Problems recognizing people, difficulty with language and thought
• *Restlessness, agitation, and wandering;repeating statements; hallucinations

• Aricept (donepezil)
• Exelon (rivastigmine)
• Razadyne (galantamine

namenda (memantine)

cana help to improve a patients symptoms up to a year or so but will not stop or reverse AD

extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. Symptoms can include weight loss, seizures, skin infections, very limited or no verbal skills ( may groan, moan or grunt), flat affect, increased sleeping, inability to ambulate, and loss of bladder and bowel control

• usually occurs from aspiration pneumonias or other infections
• caregivers can turn to a hospice for help and palliative care

• rapid onset of symptoms- often related to change in health (ex. illness, medication)
• fluctuation of level of awareness
• sudden onset of speech problems
• visual or auditory hallucinations
• sleep/wake cycle reversed
• physical cause is often identifiable:
• ex. drugs, surgery/anesthesia, change in living situation, fecal impaction, urinary retention.infections, CV problems (MI, CHF, arrhythmia), metabolic or endocrine problems

be aware of sudden changes such as sleep wake cycle reversal, agitation, worsening of confusion, disorientation

• sadness
• loss of interest
• problems eating or sleeping
• trouble concentrating
• pessimism, hopeleessness, suicidal, anorexia

• become very concrete; literal
• are offended by teasing
• confused with simple concepts ex. on or under
• neglect housework, hygiene
• cant do finances
• poor concentration

irritability, angry, argumentative, combative, suspicious

more confusion toward evening and night

• an exaggerated response; reaction is too extreme for circumstances
• *may be an attempt to escape a situation
• *may be related to too much activity or too many demands of a social situation

• environmental interventions
• *reduce stimuli
• *lower lighting
• *less noise (tv radio music)
• *reduce demands
• *postpone activities or treatments prn
• Foster consistency with
• *same caregiver
• *same routine
• *familiar surroundings

• show respect to patient
• convey a warm emotional tone
• be patient
• stay calm
• maintain compassion
• treat the patient with dignity
• assess for vision and hearing deficits
• demonstrate visually wht you are saying in words
• when frustration is high change the subject, distract, redirect or reorient the patient
• use good non-verbal techniques: eye contact, smile, slow movements, gentle touch

• cognitive-search for meaning purpose and truth
• experiental-feelings of hope, love, and connection
• behavior- external manifestation of our beliefs-how we live out our beliefs and values

• F- what is your faith
• I- is it important to you
• C- are you part of a spiritual or religious community
• A- how would u like me as your nurse to address spiritual issues in your health care

• S-spiritual belief system
• P- personal spirituality
• I-integration with spiritual community
• R- ritualized practices and beliefs
• I- implications for medical care
• T- terminal events planning

no

illness or injury

persons who require assistance over an extended period of time

in their home

2.5 years

57,000

medicaid

• hospital insurance
• free for senior citizens

• inpatient care and hospice care
• *limited coverage for some nursing home and home care
• cost for hospital care
• *patient pays a total of $1068 for 1-60
• *267 per day for days 61-90
• *534 per day for days 91-150
• *all costs past day 150

• must follow a 3 day hospital stay
• medicare pays up to 100 days in NH but on average pays for 25 days
• patient pays $134 per day for days 21-100
• covers only skilled care and only while patient is making progress in rehab
• *important for nurses to document progress!!!!!

• medicare covers some home care if the following conditions are met
• *MD orders home care and makes a plan for that care
• *the patient needs resonable and necessary part time skilled nursing care ( walkers weelchairs o2) patient pays 20% cost for durable medical equiptment
• *Patient is homebound
• * home health agency must be approved by medicare

yes

medical insurance

partial cost of MD visits and outpatient services

HMOs , PPOs, and PFFS