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Aging can affect many of the members of the family, not just the elderly family member. As family members age, there will be tough decisions to be made. One difficult decision is knowing when a family member needs nursing home placement, and how to choose a nursing home.
Nursing home residents face many ailments that are preventable or can be successfully treated before major health problems arise.
Nursing home residents often suffer common ailments as they age. Elderly individuals suffer these physical problems increasingly with age. Below is a list of common ailments in elderly nursing home residents.
| Alzheimers | Angina | Bed Sores | Behavior Problems | Contractures | Constipation | Dehydration | Gastro-Intestinal Disorders | Hypertension | Immobility and inactivity | Incontinence | Osteoporosis | Pneumonia | Pressure Sores | Urinary Incontinence | Urinary Tract Infection | Weight Loss | Nursing Home Placement |
In simple terms, Alzheimer's Disease is the death of the mind before the body. Victims of the Alzheimer's Disease often suffer from a lack of a brain chemical called acetylcholine, which promotes brain activity. Alzheimer's Disease is typically diagnosed around the age of 75, with symptoms appearing approximately three years prior to the initial diagnosis. Alzheimer's Disease causes a person to lose their perceptions of reality until they become incoherent. This loss of perception is sometimes referred to as Dementia.
By definition, angina is a fairly common type of chest pain that results from less than adequate blood supply to the heart muscles.
For the most part, coronary artery diseases cause angina. Some coronary artery diseases include aortic stenosis, hypertension, and hypertrophic cardiomyopathy. However, people with normal arteries can sometimes suffer with angina.
The heart normally receives its blood supply from the coronary arteries during the relaxation phase of a heart muscle contraction (the pumping action of the heart). When the heart needs more blood, the vessels dilate. But, when plaque lines the vessels, they cannot dilate. They lose their flexibility. Therefore, disorders involving the condition of the coronary vessels cause low blood oxygen levels and poor circulation. An obstruction of the blood vessels results in a decrease in the blood supply to the heart muscles. This is called ischemia.
Sitting or lying in one position for too long usually causes bed sores in the elderly or in immobile patients. Bed sores are easier to prevent than they are to treat. The first sign of a bed sore is a reddened area that does not go away within 30 minutes of pressure relief. Avoid rubbing or massaging red areas, which damages underlying tissues further.
When a nursing home resident doesn't shift enough while at rest, blood supply gets too low and a "bed sore" forms. Bed pressure can reduce the blood supply to the skin and the underlying tissue causing sensitivity and eventually a tough-to-treat sore.
Areas at risk for bed sores include the base of the spine, the shoulder blades, and the side of the knees, back of the head, heels and the hips. Bed sores appear on the parts of the body that don't have fat to cushion them. Bed sores are also referred to as pressure sores, pressure ulcers and decubitus ulcers.
Many nursing home residents display behavior problems, such as erratic, disruptive or difficult behavior. For instance, common behaviors might be to hit, bite or call out to get attention or to show displeasure.
One common behavior problem is a nursing home resident's refusal to cooperate with medical treatment or procedures. They may threaten those who try to administer health care services, or they may become physically abusive.
Occasionally, behavior problems are exhibited in order to produce a certain result. For example, if a resident notices that nursing home staff members hug her when she cries, then she may cry frequently. Giving her hugs regularly likely will stop the behavior problems.
Behavior problems are among the most difficult for staff and family members to manage, but they can be managed. Indeed, many behavior problems must be managed because they endanger the health and welfare of the resident and others in the facility.
Contractures are painful, disfiguring deformities of the joints, caused by immobility, and often resulting in reduced range of motion. Muscles shorten when a person endures long periods of immobility. Infrequent use causes the muscles to become rigid or fixed. Joints do not move as freely or smoothly as they once did. Movement is painful when the joint is moved because the shortened muscles are being stretched beyond their ability.
As contractures progress, a person loses all voluntary movement in the contracted joint. Bathing, dressing, and daily care become more difficult. It is harder to position a resident properly because the contracture creates pressure points that may lead to pressure sores
Constipation is a very common compliant among older persons. It is defined as defecation less than 3 times a week or straining on defecation at least a quarter of the time. Though many consider defecation every day as a sign of good health, this is not necessarily the case. Constipation can be classified into two types: functional and rectosigmoid outlet delay.
Dehydration in the elderly nursing home residents occurs when a person does not have the necessary fluid content in their body to perform normal and crucial bodily functions. Most body systems and organs are drastically affected by water deprivation. Dehydration can be especially harmful in the elderly, causing harm faster than starvation. A 10 percent loss of body fluids is serious. A 20 percent loss can result in death due to dehydration.
Peptic ulcers include gastric and duodenal ulcers. Although duodenal ulcers are more common in the general population, elderly people tend to have more problems with gastric ulcers. Nursing home residents who use non-steroid anti-inflammatory medications like aspirin and Motrin are more susceptible to peptic ulcers.
In gastro-esophageal disease, the stomach's contents flow up through the esophagus due to a relaxation of the lower esophagus - especially after meals. There are several medications that can aggravate these symptoms in elderly nursing home residents. These medications include non-steroid anti-inflammatory drugs; heart/blood pressure drugs; Estrogens; Theophylline (respiratory medicine); Tricyclic antidepressants; and Anti-Parkinson drugs.
A hiatus hernia is a condition where a hole in the diaphragm weakens to the point that the upper stomach can move up into the chest cavity. A Hiatus Hernia happens often in the elderly, and may require surgery in extreme cases.
A bland diet is recommended for gastro-intestinal disorder.
Hypertension negatively affects circulation in the brain, heart and kidneys by stressing the workload of the heart. The incidence of hypertension increases with age.
Elderly residents in nursing homes, bedridden or not, risk serious complications due to long periods of inactivity. If nursing home residents do not use the physical abilities that keep them mobile, they will lose much of their mobility.
For example, a nursing home resident who can walk, but who uses a wheelchair for ease or convenience, will gradually lose strength in his or her legs. Eventually, the resident won't be able to stand for more than a few seconds or walk any distance.
Incontinence is the inability to control one's own urinary functions. People who are incontinent urinate on themselves before they get to a toilet.
Unfortunately, incontinence is often ignored because it is considered a normal aging change, but it isn't. Most incontinence can be managed or treated.
Recognizing the need to urinate is one of the last neurological sensations to be lost in mentally confused residents. More often than not, incontinence is really a problem of communication. Mentally confused residents may not be able to convey the need to use the bathroom except through extreme behavior, such as screaming, pulling at clothing, and disrobing. The resident will likely calm down after he or she has urinated or after any wet clothing has been changed.
There are several types of urinary incontinence. Incontinence can be caused by mental or medical conditions.
Stress incontinence
Stress incontinence is most common in women. During stress incontinence, the urethral sphincter fails to hold urine because of increased pressure, caused by having multiple children, muscle weakness, and aging. Elderly nursing home residents with stress incontinence inadvertently leak when they laugh, cough, sneeze, change position, stand, lift or engage in some other physical activity.
Overflow incontinence
Overflow incontinence is commonly seen in males with prostrate problems and all residents with neurological problems.
Functional incontinence
Functional incontinence results from the physical or mental inability to urinate. Restraints or the inability to get a toilet affect the physical ability, while lack of communication skills affect the mental ability. The resident may show signs of urge incontinence.
Reflux Incontinence
Unconscious, or reflux, incontinence is a neurological dysfunction. The nursing home resident may not be aware of the need to urinate, depending on the cause of the problem. The resident is frequently or continuously incontinent, and may experience severe urgency and bladder hypersensitivity.
During the first 30 years of a person's life, the process of bone formation and bone loss ( bone resorption ) is continuous. But, at the approximate age of 30, things begin to change, and more bone if lost than is formed as a person gets older. Some reduction ( bone resorption ) in bone mass density is normal. However, when the bone loss becomes severe, it is called osteoporosis.
People with osteoporosis are much more likely to suffer fractures that are unrelated to trauma. The cause of osteoporosis is still unclear.
By definition, Pneumonia is a disease of the lungs in which whole segments of the lungs (either one side or both), usually starting in the lower lobes, become inflamed. The lungs - which resemble spongy, air-filled sacs - can no longer perform their job of taking in oxygen and disposing of waste gasses. Pneumonia almost always is the result of an invasion of the lung tissues by bacteria, viruses, or even fungi.
Once attacked, the lung tissue has an inflammatory response. The affected part swells with extra blood and body fluids in order to resist invading organisms. This wet lung tissue overloads the system, causing breathing difficulties.
By definition a pressure sore is any lesion caused by unrelieved pressure that results in damage to the skin and underlying tissue. Often times a pressure sore is a symptom of neglect and/or abuse with patients that are wheel chair or bed bound, such as the elderly. The severity of a pressure sore varies.
In general, the elderly are at a higher risk of developing pressure sores because of normal aging changes to the skin. Long-term care facilities, such as nursing homes, must recognize the resident's risk and take active preventive measures to avert these painful wounds. A pressure sore is also known as a bed sore, a pressure ulcer or a decubitus ulcer.
Pressure sores are usually caused by unrelieved pressure to the bony parts of the body such as the heels and the hips. Typically pressure sores occur when patients, especially the elderly, must stay in bed for prolonged periods of time due to aging, an injury or illness.
Urinary incontinence occurs for many reasons. Short term incontinence can be caused by urinary tract infections, vaginal infections, irritation, constipation, or even the patients medicine. If the incontinence continues, some causes include weak bladder muscles, overactive bladder muscles, blockage from an enlarged prostate, damage to nerves that control the bladder, diseases such as Multiple Schlerosis, Parkinson's or even Arthritis.
Incontinence symptoms can range from very mild leaking to severe wetting. Women are more likely than men to have incontinence.
Urinary tract infections (UTIs) often lead to acute illness in the elderly, generally affecting more women than men. Re-infections or relapses of UTIs are common.
Recent use of a catheter.
Diuretic use. Some diuretic medications can cause a person's urine to be very concentrated, requiring as many as 10 glasses of water per day to compensate.
Prostate enlargement.
Certain types of incontinence, which prevent full bladder emptying.
Uncircumcised males are at higher risk.
People who fail to drink enough clear fluids (water) increase their risk of UTIs.
Residents in long-term nursing home care frequently lose weight, especially during the first month at a facility, but weight-loss usually stabilizes. Persistent weight loss is not normal, however, and can lead to multiple complications. Weight loss accompanied by changes in protein and vitamin intake causes complications throughout the body.
The decision to place a loved one in a nursing home is very difficult for most of us. Careful consultations with your loved one, other family members and your loved one's physician are important when deciding on nursing home placement.
If a medical condition makes it impossible for a loved one to care for themselves, you must determine whether you can take care of their physical and medical needs or whether you'll need the help of others.
Many long-term care facilities and nursing homes are clean, safe, and staffed by responsible and dedicated professionals. Unfortunately, some nursing home facilities are not.
When choosing a nursing home, you should visit every nursing home facility you're considering. When you first walk into the nursing home, notice how the facility smells. Does this nursing home appear clean and well organized? Does the nursing home staff seem helpful and attentive to residents? These simple observations will alert you to the conditions that nursing home residents live with daily, and help you choose the right nursing home.
When you are choosing a nursing home facility, ask to talk with the Nursing Home Administrator. Pay attention if you feel that you are not getting straight answers. Notice when the answers are inconsistent with what you have observed.
When choosing, also talk with the nursing home staff, family members and, if possible, speak with nursing home residents who live in the facility you are considering as a choice. This will help you to judge things for yourself, rather than simply accepting what you are told by a nursing home employee.
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Irene Nursing Home Pte Ltd
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