PROBLEMS AND MANAGEMENT

OF
AGE RELATED MEDICAL CONDITIONS
AND COMMON CHRONIC CONDITION
CHRONIC CONDITIONS
 Those conditions that
last more than a year
or more and require
ongoing medical
attention and/or limit
activities of daily living
COMPREHENSIVE GERIATRIC ASSESSMENT OF
THE SELECTED CHRONIC CONDITIONS
General Ways:
1. It focuses on elderly individuals with complex
problems.
2. It emphasizes functional status and quality of life
3. It frequently takes advantage of an
interdisciplinary team of providers.
COMPONENTS OF THE GERIATRIC ASSESSMENT
1. Demographic Data
2. Chief complaint and Present Illness
3. Past medical history
4. Present medical history
5. Geriatric Nutritional Assessment
6. Habits
7. Exercise
8. Sexual Activity
9. Substance Use
 AGE RELATED MEDICAL CONDITIONS
1. Cardiovascular Diseases (CVD)
- Hypertension
- Stroke
2. Pulmonary Disease (COPD)
- Chronic Bronchitis
- Emphysema
- Asthma
- Pneumonia
 AGE RELATED MEDICAL CONDITIONS

3. Parkinson’s Disease
4. Cancer
5. Diabetes
6. Arthritis
7. Osteoporosis
 CARDIOVASCULAR DISEASES (CVD)

Non- modifiable Risk Factors causing CardioVascular Disease

1. Age – 65 yrs or over
2. Gender – higher in men than women
3. Race & ethnicity – more in blacks than to non blacks.
Modifiable Risk Factors
1. Smoking
2. Sedentary lifestyle
3. Elevated cholesterol & triglycerides.
 I. CARDIOVASCULAR DISEASES (CVD)

1. Hypertension
- a complex, chronic condition that is often
referred as “silent killer”.
- also known as high blood pressure
Pathophysiology:
Both SBP and DBP increases with age. SBP rises progressively
until the age of 70 or 80; whereas DBP increases until the age of 50 or
60 and then tends to level or even decline slightly. This combination of
changes probably reflects stiffening of blood vessels and reduced arterial
compliance and leads to a large increase in pulse pressure with aging.
Risk Factors for Hypertension :
➢Heredity
➢Race (African American)
➢ Increased age
➢Sedentary lifestyle
➢Male gender
➢High sodium intake
➢Diabetes or renal disease
➢Heavy alcohol consumption
➢Obesity
➢Some medications
Signs and Symptoms: Nursing Diagnosis:

 sweating - Decreased Cardiac Output

 anxiety / confusion - Activity Intolerance
 chest pain - Acute Pain / Headache
 severe headache - Ineffective Breathing
 sleeping problems - Imbalanced Nutrition: More
 vision problems than Body Requirement
 asymptomatic at times
 Antihypertensive Drugs:
Beta blockers – reduces the risk of
General Management for
Hypertension heart attack
Angiotensin Converting Enzymes
1. Lifestyle modification – helps control renal hyper –

2. DASH tension & risk of renal failure

3. Stop smoking Diuretics – reduces :

> blood pressure
4. Limit alcohol intake
➢ cardiac workload
➢ potassium level
 Some Types of Medications
Used to Treat Hypertension
Classification Action Example
Diuretics Decrease water and salt Furosemide (Lasix)
retention
Beta-blockers Lower cardiac output and Atenolol (Tenormin)
heart rate
ACE inhibitors Block hormone that causes Captopril (Capoten)
artery constriction
 Guidelines for HYPERTENSION Treatment in Each Stage
Risk Group Pre- Hypertension Stage 1 Stage 2 & 3

Blood Pressure S = 130 to 139 S = 140 to 159 S = 160 +

D = 85 to 89 D = 90 to 99 D = 100 +

1. No Risk Factor Life style changes Lifestyle changes Lifestyle changes

for 12 months + Drug therapy
before treatment
2. With Risk Life style changes Lifestyle changes Lifestyle changes
Factors like for 6 months then + Drug therapy
DM/ smoking start drug therapy
3. With organ or Lifestyle changes + Lifestyle changes + Lifestyle changes
Heart disease Drug therapy Drug therapy + Drug therapy
Strategies to Help Older Adults Control High Blood
Pressure :

➢Limit alcohol intake

➢ Limit sodium intake.
➢ Stop smoking.
➢ Eat a healthy diet
➢Exercise everyday
➢ Keep a healthy weight
➢Have blood pressure checked regularly
➢Report any significant rise in blood pressure to the physician.
➢Take medications as ordered. Do not skip doses.
2. Cerebral Vascular Accident (CVA) or Stroke/
Brain Attack
- a sudden loss of brain function resulting from disruption of blood supply
to the brain
Transient Ischemic Attacks – (Little Strokes) – warning strokes which
lasts between 20 mins to 24 hrs.
- It usually occur 1 to 2 years prior to the major stroke.
Two major types of stroke:
1. ischemic
2. hemorrhagic

➢The vast majority of strokes are caused by ischemia (88%),

usually from a thrombus or embolus.
➢The symptoms and damage seen depend on which
vessels in the brain are blocked.
➢Carotid artery occlusion is also a common cause of
stroke related to stenosis
 Cerebral Vascular Accident (CVA) or Stroke/ Brain
Attack

➢ Some risk factors for stroke are controllable and

others are not.
➢ The most significant risk factor for stroke is
hypertension.
➢ Controlling high blood pressure is an important way
to reduce stroke risk. Those with a blood pressure of
less than 120/80 have half the lifetime risk of stroke as
those with hypertension.
Manifestations of Stroke :

• Sudden numbness or weakness of face, arm, or leg,

especially on one side of the body

• Sudden confusion; trouble speaking or understanding

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, loss of balance or

coordination

• Sudden severe headache with no known cause

 First Aid for Stroke Management of Stroke
- TIME is critical in the (in the hospital)
treatment of stroke. 1. Maintain a patent airway,
- Provide adequate administer oxygen.
Oxygenation on the 1st 2. Monitor vital signs &
minute of the attack neurological signs or level of
- Maintain a clear airway. consciousness.
- Turn patient on the side 3. Do diagnostic tests:
to facilitate better air - lumbar puncture
entry to the lungs. - CT scan
- Cerebral angiography
 NURSING INTERVENTIONS FOR STROKE :
1. Provide necessary nursing care esp. during the acute
phase. (first 48 to 72 hrs.)
2. Monitor for signs of increased intracranial pressure (ICP)
like severe headache, nausea and vomiting
3. Provide a balanced diet and allow sufficient time for meal.
4. Teach client effective communication technique.
5. Provide safety precaution.
6. Insert indwelling catheter if with urinary incontinence.
7. Provide emotional stability to both the client & their family.
II. CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
 - group of disorders associated with varying and regular
obstruction of airflow.
Types of COPD:
1. Chronic Bronchitis
2. Pulmonary Emphysema
3. Asthma
4. Pneumonia
Common Factors that Causes COPD in Older Persons

1. Smoking
2. Exposure to air pollutants
3. Prolonged exposure to second hand smoke
4. A history of COPD symptoms
 CHRONIC BRONCHITIS
- caused by airway inflammation involving airway mucosa
edema and copious sputum production with a tendency to
airway closure on expiration.
- Causal agent for chronic bronchitis in elderly can be either
a virus or bacteria.
- Viral bronchitis occurs more often by the same viruses that
are responsible for common cold or flu.
- Viral and Bacterial bronchitis, the bronchial tubes get swollen
up due to the reaction of the body against the germs.
This is the reason for breathlessness and cough.
 Signs & Symptoms
- chest congestion
- presence of excess amount of mucus in cough
- breathlessness
- whistling sound or wheezing while breathing
- feeling exhausted
- low fever with runny nose and sore throat
- body pain and sudden chills
- cyanosis
- clubbing of fingers
 PREVENTION FOR CHRONIC BRONCHITIS
1. The elderly and their family members should be aware and
make efforts to avoid smoking and passive smoking in
order to prevent bronchitis.
2. Staying active and developing healthy habits also helps
to keep the disease away.
3. Healthy diet with proper nutrition quotient assists in staying
healthy and fresh.
4. Prevention of cold is also beneficial in keeping away
bronchitis in elderly people. S
 PULMONARY EMPHYSEMA
 - It is a damage to the alveolar structures causing the alveoli
to enlarge and be damaged resulting in reduction of the
alveolar- capillary diffusion and airway closure caused
by the loss of support for the airway structures.
- Emphysema is defined as enlargement of the air spaces
distal to the terminal bronchioles with destruction of their
walls of the alveoli.
- As the alveoli are destroyed the alveolar surface area in
contact with the capillaries decreases causing dead
spaces (no gas exchange takes place) leads to hypoxia
in later stages.
Manifestations:
➢ Chronic cough
➢ Shortness of breath
➢ Increased mucus production
➢ Wheezing

➢ Reduced appetite and weight loss

➢ Fatigue

➢ Sleeping problems
➢ Cyanotic nail beds
➢ Morning headaches due to lack of Oxygen
 Diagnostic Tests
1. Blood tests -- arterial blood gas to measure the amount of
oxygen in the blood
2. Chest X-ray or CT scan –to visualize the structures inside the chest
3. Sputum exam – identify the cause of infection & breathing
difficulties & rule out lung cancers
4. ECG - determine if shortness of breath is caused by heart
condition
5. Pulmonary function test – measure how well the lungs
6. Spirometry
 ASTHMA
 Asthma is a chronic inflammatory disease of the airways that
causes airway hyper- responsiveness, mucosal edema and
mucus production.
 Asthma creates a much greater risk for older adults because
they are more likely to develop respiratory failure as a result
of the asthma, even during mild episodes of symptoms.
 A diagnosis of asthma in older persons may be missed
because symptoms of other health conditions are similar to
asthma symptoms and may mask the specific symptoms.
WHO ARE AT RISK FOR ASTHMA IN OLDER PERSONS
 Persons with asthma during earlier life.
 Persons who are smoking.
 Persons exposed to second hand smoke.
 Persons with a history of COPD symptoms.
 Chronic Exposure to common allergens:
- environmental ( air, fumes, sprays, paint)
- medications (aspirin, antibiotics)
- food
Manifestations
Diagnostic Investigations
- Cough with or without
mucus production
1. Lung function tests
- Wheezing attacks
2. Blood tests
- Episodic shortness of breath
3. Sputum tests
- Chest tightness
4. Chest X-ray
- Prolonged strenuous
5. Skin test
expiration.
6. Family history taking
- tachycardia, diaphoresis,
7. Physical Examination
cyanosis (hypoxemia)
 MANAGEMENT OF ASTHMA
Medical Management
1. Achieve and maintain
Nursing Management
control of symptoms.
2. Prevent asthma
1. Positioning (upright position)
exacerbations.
2. Start Oxygen 50-60%.
3. Maintain pulmonary
function as close to 3. Nebulize (salbutamol) pt for
normal as possible. immediate relief.
4. Prevent development of 4. Secure IV line
irreversible airflow limitation.
5. Prevent asthma mortality.
 PNEUMONIA

- A lung inflammation caused by bacterial or viral infection,

in which the air sacs fill with pus and may become solid.
- The inflammation causes an outpouring of fluid in the
infected part of the lungs affecting either both lungs
(double pneumonia ), one lung (single pneumonia)
or only certain lobes (lobar pneumonia).
- The blood flow to the infected portion of the lung
decreases, meaning oxygen levels in the blood
stream can decline.
 CAUSES OF PNEUMONIA
1. Bacteria and viruses are the main causes of pneumonia.
(streptococcus or pneumococcal bacteria)
2. Pneumonia can be contagious. The bacteria and viruses
that cause pneumonia are usually inhaled.
3. They can be passed on through coughing and sneezing,
or spread onto shared objects through touch.
4. The body sends white blood cells to attack the infection
causing air sacs to become inflamed. The bacteria
and viruses fill the lung sacs with fluid and pus causing
pneumonia.
 Clinical Manifestations of
Pneumonia
Diagnostic Investigations
1. chest pain upon breathing
1. Upon auscultation,
or coughing
bubbling sounds (rales)
2. cough which may produce
rattling sounds (rhonchus)
phlegm (greenish or yellowish)
2. Low Oxygen saturation
3. fever and chills
3. Chest Xray or CT scan
4. Confusion or changes in
4. Sputum test (culture)
mental awareness
5. Blood C/S
5. Fatigue, body malaise
6. Shortness of breath
TREATMENT AND MANAGEMENT OF PNEUMONIA
 1. Antibiotics.
Bacterial pneumonia is always treated with antibiotics
(depending on the organism w/h triggered the disease)
Viral pneumonia receives antiviral medications
2. Cough medicines
- used to calm the cough (loosen the phlegm) and
patient is able to rest
3. Fever reducers or Pain relievers
Complications that may arise:

1 Bacteremia (infection in the

blood stream) Pneumonia Prevention
2. Pleurisy and Empyema (the
inflammation of the membrane 1. Pneumonia vaccine
covering the lungs)
2. Influenza vaccine
3. Lung abscess (pus filled cavity
3. Hand washing
develops in the infected
lung area)
4. Dental hygiene
2. Acute Respiratory Distress 5. Good Health Habits
Syndrome (respiratory failure
occur)
 PARKINSON’S DISEASE
> one of the most common neurological diseases. It affects both
men and women, particularly those over the age of 50 years

➢ A degenerative, chronic, and slowly progressing disease

➢ PD has no known etiology, though several causes are suspected
such as :
- a family history in 15% of cases.
- virus or environmental factors play a significant role in the
development of the disease.
- A higher risk of PD has been noted in teachers, medical workers,
loggers, and miners, suggesting the possibility of a respiratory
virus being to blame
> PD is a disorder of the central nervous system in which nerve cells in
the basal ganglia degenerate. A loss of neurons in the substantia nigra
of the brainstem causes a reduction in the production of the
neurotransmitter dopamine, which is responsible for fine motor
movement. Dopamine is needed for smooth movement and also plays
a role in feelings and emotions
Four cardinal signs of Parkinson’s disease:
1.bradykinesia (slowness of movement)
2. Rigidity
3. Tremor
4. gait changes

=A typical patient with PD symptoms will have some distinctive

movement characteristics with the components of stiffness, shuffling
gait, arms at the side when walking, incoordination, and a tendency
to fall backwards.
> Not all patients exhibit resting tremor, but most have problems with
movement, such as difficulty starting movement, increased stiffness
with passive resistance, and rigidity as well as freezing during motion
Management of PD is generally done through medications

1. Levodopa- a synthetic dopamine, is an amino acid that converts to

dopamine when it crosses the blood–brain barrier
= helps most of the serious signs and symptoms of PD., mainly with the
symptoms of bradykinesia and rigidity
= One important side effect to note is hallucinations.
2. Combination of levodopa and carbidopa (Sinemet)
= more common treatment, and generally the drug of choice - resulting
in a decrease in the side effect of nausea seen with levodopa therapy
alone, but with the same positive control of symptoms, particularly with
relation to movement.
3. Selegiline is another medication that interferes with one of the
enzymes that breaks down dopamine.
4. Permax and Parlodel are synthetic compounds that mimic the effect
of dopamine, but are not as powerful as levodopa.
5. Artane and Cogentin - earliest drugs used which are anticholinergics
Client/Family Teaching Regarding PD Key Areas :

➢ Medication therapy (side effects, wearing off, drug holidays,

role of diet in absorption)
➢ Safety promotion/fall prevention
➢ Disease progression
➢ Effects of disease on bowel and bladder, sleep, nutrition,
attention, self-care, communication, sexuality, and mobility
➢ Swallowing problems
➢ Promoting sleep and relaxation
➢ Communication
➢ Role changes
➢ Caregiver stress/burden—need for respite
➢ Community resources
 Aging and Cancer
Age is the greatest risk factor for developing cancer. In fact, 60% of people who have
cancer are 65 or older. So are 60% of cancer survivors. If you are an older adult with
cancer, you are not alone.
> age is just one factor in your cancer and treatment. The best treatment plan for cancer
depends on your general health, lifestyle, wishes, and other factors.
 Aging and Cancer
Strategies on how to prepare for some situations one might face as an older adult with cancer

•Coping with another disease or disability. Talk with your health care team about medications and the
treatment plan for all his conditions. And make sure your cancer doctor talks with your other doctors. It is
important for your entire health care team to know your situation.
•Getting to and from treatment and appointments. Talk with family members and health care team about
options.
•Help with daily activities. These activities may include shopping, getting dressed, or taking care of one’s
family. Options include getting help from friends or family members, hiring someone to help, or finding help
through a nonprofit organization, senior center, or your spiritual community.
•Help with meals. Good nutrition is an important part of cancer treatment. During treatment, older adults are
especially likely to lose weight without trying. This can put at risk of other health issues. It may be helpful to
have friends or family bring food, stock your pantry with foods that taste good to you, and order meals from a
service, if budget allows.
 Diabetes Mellitus
➢ Diabetes mellitus (DM) is a disorder in which the body does not
make enough insulin, or cannot effectively use the little insulin that it
does produce.
➢ Two major types of diabetes:

1. Type 1 (insulin dependent or IDDM)

➢ generally occurs in children and used to be known as juvenile onset
diabetes. It is characterized by hyperglycemia and little or no insulin
production.

2. Type 2 (non-insulin dependent or NIDDM)

> is seen in the vast majority of those with diabetes and is managed
more often by diet, exercise, and oral medications.
 Diabetes Mellitus
➢the seventh leading cause of death among older adults.
The risk of diabetes increases with age, as does mortality
from this disease.
➢Risk factors include:
= family history
= obesity
= race (African Americans, Hispanics, Native Americans,
Asian Americans, Pacific Islanders), = age over 45
= hypertension (greater than or equal to 140/90)
= less “good” cholesterol (less than 35 mg/dl)
= history of large babies
 Diabetes Mellitus
Management is successful when a balance is achieved
among :
➢ Exercise
➢ Diet
➢ Medications - may be oral hypoglycemics or insulin
injection (needed in Type 1).
= Nurses will need to do a significant amount of teaching
regarding the signs and symptoms of hyper- and
hypoglycemia and the role of medications in managing
blood sugar.
Key Areas for Nursing Teaching of Older Persons with Diabetes
➢Proper nutrition
➢Exercise
➢ Medications
➢Signs and symptoms of hyper- and hypoglycemia
➢Meaning of lab tests: FBS, blood glucose, HgbA1c
➢Use of a glucometer
➢Foot care
➢Importance of adherence to therapeutic regimen
➢Possible long-term complications
➢Prevention of complications
 Osteoarthritis
> Osteoarthritis (OA) is also called joint failure syndrome
or degenerative joint disease.

➢ The cause of OA is unknown

➢ but it affects females more often than males
➢ risk increases with certain factors such as :
- Persons who are over age 45
- Obese
- have a history of sports injuries to the joints
- a family history of OA are thought to be at increased risk.
- Weakness of the muscles around the knee joint is another predisposing factor
Signs and symptoms of Osteoarthritis include:

➢Pain
➢stiffness (especially in the morning)
➢aching
➢some joint swelling
➢inflammation.
➢OA targets joints such as the fingers, feet, knees,
hips, and spine
 Management of Osteoarthritis
Pharmacotherapy for OA generally consists of :
➢ Analgesics
➢ NSAIDs
➢ Corticosteroids
➢ Viscosupplementation
➢ symptomatic slow-acting drugs (i.e., nutraceuticals).
= Improving function and quality of life are the goals of pain
➢ To achieve these goals, a multidisciplinary application of both nonpharmacologic
and pharmacologic approaches is often necessary such as :
➢ Both aerobic and strengthening exercises seem to be equally effective to reduce
pain and improve function.
➢ Management regimens that can slow, alter, or reverse the degenerative process
of OA continue to be sought.
 Osteoporosis

> is a bone disorder characterized by low bone density or

porous bones.

> A major complication of osteoporosis is fractures. These

are especially common in the vertebral spine, hips, and
wrists.
Risk Factors for Osteoporosis
➢ Personal history of fracture after age 50
➢ History of fracture in a first-degree relative
➢ Being female
➢ Being thin and/or having a small frame Advanced age
➢ A family history of osteoporosis
➢ Estrogen deficiency as a result of menopause
➢ Anorexia nervosa
➢ Low lifetime calcium intake
➢ Vitamin D deficiency
➢ Use of certain medications, such as corticosteroids and anticonvulsants
➢ Presence of certain chronic medical conditions
➢ Low testosterone levels in men
➢ An inactive lifestyle
➢ Current cigarette smoking
➢ Excessive use of alcohol
Treatment of existing osteoporosis takes many forms:
➢ Postmenopausal women are often prescribed biphosphonates
(such as Fosamax), calcitonin (Miacalcin), or estrogen/hormone
replacement medications (such as Estratab or Premarin).
➢ Some of these medications are aimed at promoting adequate
amounts of calcium in the bones, whereas the hormone
replacement therapies replace estrogen not being produced after
menopause to create more of a balance between the delicate
hormones that guide bone reabsorption and demineralization.
➢ The use of estrogen replacement therapy has been shown to
decrease the incidence of serious fractures in postmenopausal
women