Why it is more difficult to care for an 80 year old patient than a 20 year old patient? (<250 words) (Example 1) The process of aging is accompanied by many changes in the physical state of the body that can complicate care of an elderly patient. Disease causing factors such as radiation exposure or environmental toxins have impacted upon an elderly person for a relatively longer number of years, and damage has, therefore, accumulated. Additionally, the aging process itself predisposes the elderly to health complications through numerous means: (1) long-term environmental stress leads to increased corticosteroid production which can lead to immune suppression and decreased healing; (2) the elderly experience loss of organ reserve capacity and complexity which results in decreased ability to cope with trauma and disease; (3) the accumulation of free radical damage, cellular "garbage", and DNA damage with mutations makes cells less resilient and more prone to disease; (4) natural aging involves a decrease in bone mass, a decrease in immune response, and changes in other organ systems (decreased cardiac output, decreased glomerular filtration rate). Atherosclerosis is another process that occurs with aging which is complicated by the difficulty some elderly have in obtaining exercise and eating a low fat-low cholesterol diet. "Polypharmacy", or the use of many medications by the elderly, also complicates their care. |
Why it is more difficult to care for an 80 year old patient than a 20 year old patient? (<250 words) (Example 2) There are several normal physiologic differences in the elderly that make treating them challenging. For example, older patients tend to take more medications and experience presbyopia or senility that make it more difficult to comply with instructions. Due to the increased number of medications, along with decreased glomerular filtration rate, and the decreasing ability of the liver to metabolize these drugs, many interactions and unexpected complications may occur. In addition, starting an IV or performing other procedures can more easily damage vessels and skin. Elderly patients are more likely to experience multiple, chronic problems such as an increased risk for cancer (such as breast or colon or prostate), increased atherosclerosis, a decrease in immune function, longer healing times, and decreased compensatory mechanisms in response to injury. A decrease in muscle mass and maximal heart rate makes preventive care such as exercise harder and less productive, but still beneficial. While a decrease in spermatogenesis is probably not a clinical problem, ovarian atrophy with menopause necessitates discussing estrogen therapy, without which older women have an increased risk for osteoporosis and heart disease. As a result of these problems, caregivers must thoroughly understand and account for these possibilities. |