Benign prostatic Hyperplasia in the Older Man

As men age the prostate gland enlarges, which causes the layer of tissue surrounding it to stop expanding and starts to press against the urethra. The prostate also extends upward into the bladder causing it to become weak leading to incomplete emptying of the bladder and urinary retention. Even the smallest amount of urine makes the bladder contract leading to frequent urination. Urinary tract infections occur due to urine that sits in the bladder. The cause is uncertain but has been linked to men with testosterone levels above the median. Risk factors include; smoking, heavy alcohol consumption, hypertension, heart disease and diabetes. Men usually don't know until the ability to urinate is non-existent due to obstruction. Over the counter allergy medication are said to prevent the bladder from relaxing and allowing urine to flow, which may cause them to visit the hospital. A digital rectal exam reveals a large, rubbery non-tender prostate gland. Prostate Specific Antigen (PSA) may be drawn to rule out cancer. Urine flow study may be done to measure how quick urine is flowing. FDA have approved 6 drugs to relieve symptoms of BPH. These drugs are proscar, avodart, hytrin, cardura, flomax and uroxatral. For worse cases surgery may be needed to remove the enlarged tissue that press agaisnt the urethra to relieve the obstruction. It is important for men to get regular exams after age 40 to determine the size of the prostate and whether treatment is needed.

References

Cheever H. K. & Bare, G. B. & Hinkle L. J. & Smeltzer C. S. Assessment and management of

problems related to male reproductive processes. (11^th ed). Textbook of Medical-Surgical Nursing (pp.1751-1752). Philadelphia, PA: Lippincot

www.kidney.niddk.nih.gov

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Cataracts are a Common Cause of Vision Loss in the Elderly

A Cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light. Early in the development of age-related cataract the power of the lens may be increased, causing near sightedness, and the gradually yellowing and opacification of the lens may reduce the perception of blue colors.

Cataracts typically progress slowly to cause vision loss and are potentially blinding if untreated. The condition usually affects both eyes, but almost always one eye is affected earlier than the other.

Cataracts are very common in older adults that some almost consider them an inevitable consequence of old age. According to the University of Washington, Department of Ophthalmology (2008) 400,000 new cases of cataract development are diagnosed each year, 1,350,000 cataract extractions are currently performed each year and 5,500,000 people have visual obstruction due to cataracts.

In many countries surgical services are inadequate, and cataracts remain the leading cause of blindness. As populations age, the number of people with cataracts is growing. Cataracts are also an important cause of low vision in both developed and developing countries.

Cataracts develop for a variety of reasons, including long-term exposure to ultraviolet light, exposure to radiation, secondary effects of diseases such as diabetes, hypertension and advanced age, or trauma, cigarette smoking and high alcohol intake. Although about half of people between 65 and 75 years of age have cataracts, they are most common in those over age 75 and there are no ethnic or gender variations.

After one has clear vision that is compromised, the most effective treatment for cataracts is surgery. This is the most common operation among older adults and more than 95% of them have better vision after surgery. The benefits of surgery include improved visual acuity, depth perception, and peripheral vision, leading to better outcomes related to ADLs and quality of life. This procedure is safe and done in an outpatient clinic. Complications are rare, but include retinal detachment, infection, and macular edema.

If we can educate patients to control their hypertension as well as their diabetes, also their light and radiation exposure perhaps it may help reduce the number of older patients that will form cataracts.

REFERENCES

Mauk, K.L. (2010) Gerontological Nursing. Competencies for Care (2^nd ed). Sudbury MA: Jones and Bartlet Publishers

HTTP://en.wikipedia.org/wiki/Cataract

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Decreasing anxiety in the elderly

Chronic anxiety can complicate many illnesses such as hypertension, heart disease, chronic obstructive pulmonary disease, diabetes and may interfere with ADL’s, and cause cognitive decline and impairment, especially in the elderly.

Anxiety and pain perceptions in a population over the age of 65 showed that anxiety significantly elevated acute pain perception.

Some of the risk factors for anxiety are, excessive worrying, restlessness, irritability, sleep disturbances, fatigue and impaired concentration.

Older adults with chronic medical conditions are at a much higher risk for development of anxiety disorders when compared to those with-out chronic illnesses.

Drugs that can cause or worsen anxiety are, caffeine, theophylline, pseudoephedrine, and baclofen.

Instruments available to assess anxiety are, the Stat-Trait-Anxiety Inventory(STAI) and the Hospital-Anxiety-Inventory.

Interventions are, giving instructions to painful procedures, and in self management of pain, relaxation, breathing techniques, distraction, and cognitive restructuring can decrease anxiety.

Some medical conditions can cause or exacerbate anxiety in the elderly, such as hypoglycemia, hyper thyroidism, cardiac arrhythmia, hypertension and COPD.

The death of a spouse significantly increases the incidence of anxiety in older adults, catastrophic events in early life, poor subjective health, lack of an adequate support network, loneliness, and perceived vulnerability are also contributing factors for developing anxiety in the elderly.

Some medications to treat anxiety are, benzodiazepines, which have many side-effects, and serotonin norepinephrine re-uptake inhibitors (SNRi’s), and the selective serotonin re-uptake inhibitors (SSRI’s). The first line of treatments are the SSRI’s, because they have fewer side-effects.

Reference

Mauk, K. (2010). Gerontological Nursing Competencies for Care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a registered nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.