A bone mineral density test called dual energy x-ray absorptiometry, often called a DEXA-scan or DXA , can detect osteoporosis before a fracture occurs, predict the chances of fracturing in the future, determine the rate of bone loss, or monitor the effects of treatment if the test is conducted at intervals of 1 year or more. For postmenopausal women, the bone mineral density is interpreted as normal, osteopenia (low bone mass), osteoporosis, or severe osteoporosis. Various medications that reduce reabsorption of bone are effective in increasing bone density and decreasing fractures. Response to these medications cannot be expected in less than 1 year; repeat bone mineral density testing measurements taken after 2 years are more reliable. The ultimate measurement for effectiveness is the incidence or lack of fractures. The following are teaching points for keeping the bones healthy: ● Do weight-bearing exercises at least five times per week. ● Get 1,200 mg of calcium every day. Foods high in calcium include low-fat dairy, green leafy vegetables, and fortified foods such as orange juice. Physicians will inform patients if they need supplements. Too much calcium can be
dangerous, and calcium interacts adversely with many medications. ● Increase vitamin D. Vitamin D can be obtained with 20 minutes of sun exposure. Eggs, fatty fish, and fortified milk are also good sources. Recommended daily doses for those ● If prescribed medication to help prevent bone loss, take it exactly as prescribed. Some require a full glass of water and remaining upright for 30 minutes. ● Practice safety measures in and around the home and community to prevent falls. ● Assess and teach intrinsic and environmental safety issues for fall prevention. (NIH, 2015) older than age 70 is 800 IU (NIH, 2016). ● Avoid smoking and limit alcohol intake. Osteoporosis is preventable, and the good news is that a person is never too old to start preventive measures. Encourage older adults to implement lifestyle habits that will strengthen their bones and help prevent fractures.
OSTEOARTHRITIS
Osteoarthritis is a noninflammatory, progressive, degenerative disorder of the movable weight-bearing joints. It is the most common rheumatologic disorder. It is estimated that 27 million Americans are affected by osteoarthritis (Arthritis Foundation, 2016). The prevalence among men and women is equal (Arthritis Foundation, 2016). In addition to age, risk factors include joint injury, obesity, and mechanical stress. The most common signs and symptoms include stiffness after a long period of immobility; morning stiffness, joint pain that occurs with activity, limitation of movement, and crepitus; aching or nagging discomfort, usually experienced with motion, weight bearing, or activity; and “flare-ups” of the disease that are associated with the use or abuse of the joint or trauma, and are commonly relieved with rest. The major goals of treatment include preservation of function, reduction of pain, and minimization of further damage to involved joints. Pain is generally treated with acetaminophen, Cardiovascular accidents are the leading cause of disability in the country and the fourth leading cause of death (Heron, 2016). A transient ischemic attack (TIA) is sometimes called a little stroke but is actually a precursor to a cerebrovascular accident (CVA), also known as a stroke. A TIA may be recognized by focal neurological signs that occur suddenly, last a short time, and resolve completely within 24 hours. Most TIAs are caused by partial blockage of arteries in the neck. A small blood clot may lodge in a carotid artery and temporarily prevent blood flow to a part of the brain. As blood flow is restored, the symptoms disappear without permanent damage. Symptoms of a TIA vary from person to person but may include blurred vision or speech, flashes of light, migraine, vertigo, facial weakness, confusion, and ataxia. Patients experiencing a TIA should be evaluated in an emergency room, so a disabling stroke may be prevented by medications or a carotid endarterectomy. A CVA is the term used to describe neurological deficits resulting from an interruption of the blood supply to the brain. When blood can no longer flow to the brain, brain cells die. A stroke may be caused by a blood clot or it may be a hemorrhagic stroke, which refers to neurological deficits that occur as a result of bleeding within the cranial cavity. A stroke is an emergency situation and all older adults should be aware of the warning signs and know to call 911 right away. To raise awareness, the American Stroke Association has developed the acronym “F-A- S-T” to the public to recognize and seek treatment for potential stroke victims: “F” stands for facial droop; “A” stands for arm weakness; “S” stands for speech difficulty; and “T” stands for
nonsteroidal anti-inflammatory drugs, and sometimes opioids. Things to teach your patient to maintain a healthy lifestyle include: ● Prevention of falls and injuries. ● Encouragement of low-intensity exercise. ● Encouragement of weight loss if over ideal body weight. ● Use of pain medications as prescribed. ● Use of assistive devices, such as a cane or walker or gripping and grabbing tools (Arthritis Foundation, 2016). Older adults may believe in “miracle cures” or such unproven remedies as copper bracelets. Items that boost large claims, cure many conditions, have no warnings about adverse effects, sound too good to be true, or have testimonials rather than research are probably useless. Try to protect older adults from spending large sums of money on these types of products. However, something simple, such as an inexpensive copper bracelet, is harmless and probably should not be discouraged.
STROKE
time to call 911. Additional warning signs to teach the older adult include: ● Sudden numbness or weakness in the face, arm, or leg, especially if it is on one side of the body only. ● Sudden confusion, difficulty speaking or understanding, or slurred speech. ● Sudden problems with vision in one or both eyes. ● Sudden dizziness, loss of balance or coordination, or difficulty walking. ● Severe sudden headache with no known cause. ● Inability to smile fully. ● Inability to raise both arms equally. There are two stages associated with recovery from a CVA, the acute stage and the rehabilitative stage. Cerebral edema occurs initially and is the leading cause of death during the first week of recovery. Once the patient is stable, the rehabilitation stage takes place. The focus during this stage is to regain function, prevent further strokes, and avoid complications. It is important to motivate your patient during this phase because most rehabilitation occurs within the first 6 months. Ultimately, recovery depends on the extent of brain injury and rehabilitation (National Institute of Neurological Disorders and Stroke, 2014). It is important for the patient’s family members and friends to understand the difference between a left- and right-sided stroke. Use the materials in Table 4 to educate the patient’s family and friends. To lower the risk of having a stroke, teach older adults to control their blood pressure, stop smoking, get regular exercise, eat a heart-healthy diet, and keep diabetes under control.
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