Cognitive Disorder Associated with Aging.

ALZHEIMER'S DISEASE (AD)

Fig. 1. The physiological structure of the brain and neurons in (a) healthy brain and (b) Alzheimer’s disease (AD) brain.

This is the most common type of dementia that typically affects people older than 65 years. It is a problem with the central nervous system; the brain ( Touhy & Jett, 2020). AD can be defined as a slowly progressive neurodegenerative disease characterized by neuritic plaques and neurofibrillary tangles (Figure 1) as a result of amyloid-beta peptide (Aβ) accumulation in the most affected area of the brain, the medial temporal lobe, and neocortical structures. Alois Alzheimer noticed a presence of amyloid plaques and a massive loss of neurons while examining the brain of his first patient that suffered from memory loss and a change of personality before dying and described the condition as a serious disease of the cerebral cortex.

Causes

The exact cause of Alzheimer’s is unknown. It has been well established that age, gender, and genetics are the most important risk factors. As older adults age more, they become more at risk for the disease. Women are more likely than men to have the disease.

Other risk factors include chemical imbalances, environmental agents, immunological changes, excessive stress, and ethnicity/race. Environmental agents: certain viruses such as herpes zoster, and herpes simplex, and toxic metals such as Zinc and copper. Patients who have experienced a traumatic brain injury (e.g. war veterans) or repeated head trauma (e.g. football players) may be more at risk for AD and at an earlier age than others. There is also a high incidence of AD in people who have Down Syndrome.

Common symptoms

One of the first symptoms is short-term memory loss and difficulty recalling new information, forgetting names, misplacing household items, denying the presence of symptoms, degenerating impaired cognition, and problems with judgment. Restlessness may be decreased if the person is taken for frequent walks. As the disease progresses, the patient loses all cognitive abilities, is totally unable to communicate, becomes less aware of the environment, and loses abilities to perform ADLs.

Treatment:

Pharmacological: Currently, there are only two classes of approved drugs to treat AD, including inhibitors to cholinesterase enzyme and antagonists to N-methyl d-aspartate (NMDA), which are effective only in treating the symptoms of AD, but do not cure or prevent the disease (Breijyeh, & Karaman, 2020).  

Non-Pharmacological: Behavioral management in a structured environment, cognitive stimulation, and memory training like the use of interactive pet therapy to enhance cognitive function for patients with mild to moderate cognitive impairment.

Orientation and Validation therapy: Reality orientation is usually appropriate for patients with early AD. Always reorient the patients to date, time, place, and thing. As the disease progresses, validation therapy is used whereby the patient’s feelings and concerns are recognized and acknowledged (Ignatavicius et al., 2018).

Specific strategies to promote the individual’s health, well-being, and quality of life

Encourage family members to provide pictures of family members and close friends with their names on them to help the patient with recognizing them. Families should reminisce with the patient about pleasant experiences from the past and put the picture of the patient in the door room to help the patient locate the room. It is okay for the patients to talk to themselves in a mirror but if frightened by the mirror, it should be removed or covered. It is important to keep environmental distractions and noise to a minimum so patients will not be more confused, anxious, agitated, and/or aggressive. Be gentle and respectful. Tell the person what you are going to do, step by step while you help them bathe or get dressed. Serve meals in a consistent, familiar place and give the person enough time to eat (HHS, 2021). As the disease progresses, altered thought processes affect the ability to perform ADLs. Encourage the person to perform as much self-care as possible and to maintain independence in daily living skills as long as possible.

Local resources/services to help individuals and families coping with Alzheimer’s

Alzheimer's & Dementia Resource Center (Non-profit organization).

Location: 1410 Gene St, Winter Park, FL 32789

Contact information: (407) 436-7750

Website: https://adrccares.org/

Resources for Alzheimer's Care

Here are some places that can give you support and advice:

NIA Alzheimer's and Related Dementias Education and Referral (ADEAR) Center

Email the ADEAR Center

Phone: 1-800-438-4380

References:

Jett, K. (2020). Neurodegenerative disorders. In T.A. Touhy & K. Jett (Eds.), Ebersole & Hess' Toward healthy aging: Human needs and nursing responses (10th ed. pp. 371 - 394). Elsevier.

Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer's Disease: Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https://doi.org/10.3390/molecules25245789

U.S Department of Health and Human Services (HHS) (2021). Tips for caregivers and families of people with dementia. https://www.alzheimers.gov/life-with-dementia/tips-caregivers.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R. (2018). Medical-surgical nursing concepts for interprofessional collaborative care (9th ed.). Elsevier.

 

ADDING AN OLDER ADULT TO THE HOUSEHOLD

Sharing a home with an older adult has some advantages and disadvantages. In most cases, these advantages, and disadvantages, depending on the older adult’s health and level of independence. Sharing a home with an older adult may give rise to some potential areas of conflict in my life. My family structure is that of a nuclear family; a husband, two teenage boys, and a girl. Every home in my house is fully furnished including my guest home. So having an older adult move in with possessions will be a hard decision to accept. I will be left to either empty the room off my belongs or allow just a few special belongings from my new household member. With the new addition, I will have to take extra work shifts in other to avoid financial strain on my family, and this will affect family time.

It is very important that families are educated on what to expect or have done in preparation for an older adult becoming a member of the household.

Adding an older adult to the household requires a lot of preparation. You have to know the needs of the new member and of the family, and how these needs can be met. You have to allot space for the new member. Planning should be done on including the older adult in the existing family pattern, what community resources can assist the older adult to adjust to the new environment, is the new environment safe, how will this transition affect your family life, and how your family feels and as well as knowing the skills and talents that the older adult has (Touhy &  Jett, 2020)

There are different family structures, and they operate differently. A family structure that has young children may be more welcoming to having an older adult becoming a member of the household because the new member may assist with childcare thereby saving them daycare fees.

In another family structure, there may be a great need for companionship maybe for an existing member of the family, so having a new older adult in the household may likely solve the problem. Some other family structure may be such that takes care of their older adults as their responsibilities, they are more aware of their needs and work to resolve problems while finding ways to meet the needs of members.

Many family caregivers support their loved ones at a significant cost to their own physical, emotional, and financial well-being but no matter the family structure, it is important to recognize potential areas of conflict and ways to decrease areas of conflict.

It is important to discuss space allocation, especially if someone has given up their space to an older relative. When I had a smaller home, and my father-in-law came to stay with us, it was hard for my son to give up his room for him, so we had to have a round table discussion with him, then another one with my father-in-law present. After this, he came to an understanding that he did an honorable thing and set a good example for his younger siblings to emulate. His grandfather also appreciated the fact that he gave up his room for him.

You should make a clear decision about the household task. Out of respect for the new member of my household, we were doing everything for him thinking we were helping him, until he started complaining of being bored, and not having anything to do. His Son started becoming worried about his father and I approached him and asked him what we could do to make his stay smoother, then he said he needs to be doing things himself that he can do laundry, help with the lawn as well as help make dinners. So, we gave in to his request except for the dinner part because he forgot to turn off the stove on time. Increased social isolation and loneliness are associated with higher risks for health problems, such as depression; heart disease; and cognitive decline, which is a decrease in the ability to think, learn, and remember (NIH National institute on aging, 2022).

References

Touhy, T.A. (2020). Relationships, roles, and transitions. In T.A. Touhy & K. Jett (Eds.), Ebersole & Hess' Toward healthy aging: Human needs and nursing responses (10th ed. pp. 452 - 469). Elsevier.

NIH National institute on aging (NIA) (2022). Healthy Aging Tips for the Older Adults in Your Life. https://www.nia.nih.gov/health/healthy-aging-tips-older-adults-in-your-life

AGING AND NURSING 

Physical changes due to aging.

There are so many physical changes that occur due to the aging process.

These changes affect some organs and systems in the human body.

The organs are:

Heart

Bone, Muscle & Joint

Digestive System

Kidney and urinary tract

Brain & Nervous System

Eyes

Ear

Hair, Skin & Nail

Weight

Heart

Your heart pumps all day and night, whether you are awake or asleep. It will pump more than 2.5 billion beats during your lifetime! As you age, blood vessels lose their elasticity, fatty deposits build up against artery walls and the heart has to work harder to circulate the blood through your body. This can lead to high blood pressure (hypertension) and atherosclerosis (hardening of the arteries).

Taking care of your body with the right types of fuel will help you keep your heart healthy and strong. You can take care of your heart by exercising and eating heart-healthy foods.

Bone, Muscle & Joint

                                                                                                                                    

As we age, our bones shrink in size and density. Some people actually become shorter! Others are more prone to fractures because of bone loss. Muscles, tendons, and joints may lose strength and flexibility. 

The most common musculoskeletal disorders in later life are Osteoporosis, rheumatoid arthritis, and gout (Touhy & Jett, 2020).

 There are other major risk factors for bone diseases. These are; whites and Asians are at the highest risk, low body weight, family history of osteoporosis, estrogen deficiency, inadequate calcium, and vitamin D intakes, lack of weight-bearing activities,  smoking and exposure to tobacco smoke, etc.

Exercise is a great way to slow or prevent problems with bones, muscles, and joints. Maintaining strength and flexibility will help keep you strong. In addition, a healthy diet including calcium can help your bones be strong. Be sure to talk to your doctor about what types of diet and exercise are right for you.

 Digestive System

Swallowing and digestive reflexes slow down as we age. Swallowing may become harder as the esophagus contracts less forcefully. The flow of secretions that help digest food in the stomach, liver, pancreas, and small intestine may also be reduced. The reduced flow may result in digestive issues that weren’t present when you were younger.

Kidneys and Urinary Tract

Kidneys may become less efficient in removing waste from the bloodstream because your kidneys get smaller as they lose cells as you age. Chronic diseases such as diabetes or high blood pressure can cause even more damage to the kidneys.

Urinary incontinence may occur due to a variety of health conditions. Changes in hormone levels in women and having an enlarged prostate in men are contributing factors that lead to urinary incontinence.

 

Brain and Nervous System

As we age, we naturally lose cells. This is even true in the brain. Memory loss occurs because of the number of brain cells decreases. The brain can compensate for this loss by increasing the number of connections between cells to preserve brain function. Reflexes may slow down, distraction is more likely and coordination is affected.

Eyes

There are many vision changes that occur as we age. We may need help seeing objects that are closer as our lens stiffens. We may have a more difficult time seeing in low-light conditions, and colors may be perceived differently. Our eyes may be less capable of producing tears and our lenses may become cloudier.

Common eye problems associated with age include cataracts, glaucoma, and macular degeneration.

 

Ears

Excessive noise throughout your lifetime can cause hearing loss as you age. Many older adults have difficulty hearing higher pitched voices and sounds, trouble hearing in busy places and more frequently accumulating earwax.

 

 Hair, Skin, and Nails

As you age, your skin becomes more dry and brittle, which can lead to more wrinkles. The fat layer under the skin thins, which results in less sweating. This may seem like a good thing, but it makes you more susceptible to heat stroke and heat exhaustion in the summer. Hair and nails grow slower and become brittle. Hair will thin and turn gray.

 Weight

Decreasing levels of physical activity and a slowing metabolism may contribute to weight gain. Your body may not be able to burn off as many calories as it once could, and those extra calories will end up being stored as fat.

We currently live in a world where aging is so common that it’s considered by most of the world, including the medical community, as something that’s natural and inevitable. And if something’s considered inevitable, typically you don’t focus on it in the same way as something you can treat.

According to Harvard Gazette, one of the biggest changes that happened in 2018 was the World Health Organization, in their international disease codebook, declaring aging a condition that is treatable. So now doctors and countries can report back to the World Health Organization how many people in their country are suffering from this condition known as “old age.” Aging is a process that most people find difficult to accept while others may accept it and do the best they can to achieve healthy aging.

Today, many people are doing a lot of procedures to halt aging or delay aging. These procedures may be in the form of surgeries, the use of herbs, drugs, and also the use of cream and lotions.

Invasive procedure to reverse the natural changes of aging.

Chemical Peels: 

A chemical peel is a procedure in which a chemical solution is applied to the skin to remove the top layers. The skin that grows back is smoother. With a light or medium peel, you may need to undergo the procedure more than once to get the desired results (Mayo Clinic).

Chemical peels are used to treat wrinkles, discolored skin, and scars — usually on the face. They can be done alone or combined with other cosmetic procedures. And they can be done at different depths, from light to deep. Deeper chemical peels offer more-dramatic results but also take longer to recover from.

A chemical peel can cause various side effects, including:

Redness, scabbing, and swelling. Normal healing from a chemical peel involves redness of the treated skin. After a medium or deep chemical peel, redness might last for a few months.

Scarring. Rarely, a chemical peel can cause scarring — typically on the lower part of the face. Antibiotics and steroid medications can be used to soften the appearance of these scars.

Changes in skin color. A chemical peel can cause treated skin to become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation). Hyperpigmentation is more common after superficial peels, while hypopigmentation is more common after a deep peel. These problems are more common in people with brown or black skin and can sometimes be permanent.

Infection. A chemical peel can lead to a bacterial, fungal, or viral infection, such as a flare-up of the herpes virus — the virus that causes cold sores.

Heart, kidney, or liver damage. A deep chemical peel uses carbolic acid (phenol), which can damage the heart muscle and cause the heart to beat irregularly. Phenol can also harm the kidneys and liver. To limit exposure to phenol, a deep chemical peel is done a portion at a time, in 10- to 20-minute intervals.

This procedure can be prescribed for medical reasons but today, some older adults travel to countries with almost no restrictions or regulations to get such procedures done in other to have tight firm skin without wrinkles. 

What these private cosmetologists fail to tell them is that chemical peels can't remove deep scars or wrinkles or tighten sagging skin.

As nurses, before any patient undergoes any procedure, it is our duty to make sure that they are well informed by the physician on the pros and cons of the surgery and that all the concerns and questions are addressed to their understanding before they sign the consent to proceed.

References

Touhy, T.A., & Jett, K. (2020). Ebersole & Hess' Toward healthy aging: Human needs and nursing responses (10th ed.). Elsevier.

https://www.mayoclinic.org/tests-procedures/chemical-peel/about/pac-20393473

Sunil, C. (2020). The modification of the aging process. DOI - 10.18231/j.agems.2020.001

Harvard gazette. (2019). Longevity and anti-aging research: prime time for an impact on the globe. https://news.harvard.edu/gazette/story/2019/03/anti-aging-research-prime-time-for-an-impact-on-the-globe/