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Geriatric DisordersBy: Kirk Odrey O. Jimenez, B.S.N., R.N.

Geriatric Nursing

IntroductionOf all the animals in this planet, we humans go furthest beyond the stage of procreation. We continue to grow and develop into our grey years.

Growing old is a natural part of life, our bodies changes with the passing of time and like rocks upon a flowing stream, it withers.

This is the faith of all mortal men, the body moves from birth to death in a straight one-way line and with that evidence of ware and tare start to appear.

Introduction

This presentation aims to impart the common health conditions that an older adult will experience as he journeys through life. In this presentation are common diseases per system and its corresponding interventions that they may be delayed of prevented.

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Sensory System Disorders of the Older Adult

Cataract 

Definition  A cataract is a clouding of the eye's lens that leads

to decreased vision. The lens of the eye focuses an image onto the retina at the back of the eye. This is where an image is processed and then sent to the brain.

As the cataract matures, it often causes glare, as well as decreased vision, contrast, and color sensitivity.

Causes  The lens of the eye is made of mostly water and

protein. The protein is arranged in a way that keeps the lens clear and lets light pass through it. A cataract forms when some of the protein clumps together and starts to cloud an area of the lens. A cataract won't spread from one eye to the other, although most people develop cataracts in both eyes at a similar times.

There are several causes of cataracts, including: Aging (the most common cause) Smoking Diabetes Infection Injury Exposure to radiation Taking adrenal cortical hormones for a long time Excessive exposure to sunlight Birth defect

Risk Factors  A risk factor is something that increases your chance of getting a

disease or condition. Risk factors for cataracts include: Age Exposure to UV-B radiation from sunlight Family members with cataracts Diabetes Trauma Smoking

Symptoms  When a cataract is in the early stages, you may not

notice any changes in your vision. Cataracts tend to mature slowly. Vision gets worse gradually. Some people with a cataract find that their close-up vision suddenly improves, but this is temporary. Vision is likely to worsen as the cataract becomes more cloudy. Because the decrease in vision is gradual, many people do not realize that they have a cataract until it is discovered during an otherwise routine eye examination.

Symptoms include: Cloudy or blurry vision Problems with light, including:

Headlights that seem too bright at night Glare from lamps or very bright sunlight A halo around lights Colors seem faded Poor night vision Frequent changes in your eyeglass or contact lens

prescription

Diagnosis  A comprehensive eye examination usually

includes: Visual acuity test—an eye chart test that measures how

well you see at various distances Pupil dilation—the pupil is widened with eye drops to see

more of the lens and retina Tonometry—a standard test to measure the pressure inside

the eye. Increased pressure may be a sign of glaucoma .

Treatment  For an early cataract, vision may be improved by using

different eyeglasses, magnifying lenses, or stronger lighting. If these measures don't help or if vision loss interferes with your daily activities, such as driving, reading, or watching TV, surgery is the only effective treatment.

Cataract surgery is almost never an emergency. Therefore, in most cases, waiting until you are ready to have cataract surgery will not harm your eye. However, your cataract will only get more cloudy with time.

Cataract surgery is almost always performed in one eye at a time. After the cloudy lens is removed, the eye surgeon (ophthalmologist) places an intraocular lens (IOL) in its place. An IOL is a clear lens that requires no care and becomes a permanent part of your eye.

After cataract surgery, most people need reading glasses and many people need glasses for distance. There is a relatively new option, multifocal intraocular lenses, which focus for both near and far distance in the same lens. Many patients who receive multifocal intraocular lenses see well at both a distance and nearby without glasses.

Although every surgery has risks, the majority of patients who have cataract surgery have better vision afterward.

Prevention  Although there is no way to completely prevent cataracts, the

following precautions may help: Do not smoke. Consume antioxidants (such as antioxidant vitamin

supplements). Wear a hat and UV-protected sunglasses when outdoors. It is also important to get a comprehensive eye examination

regularly. But since vision problems increase with age, if you are aged 60 or older, you should have a comprehensive eye examination once a year.

Hearing Loss 

Definition  Hearing loss is a decreased ability to hear. There are two

main categories of hearing loss: Conductive hearing loss due to something interfering with

the sound passing to the inner ear Sensorineural hearing loss due to damage to: The major organ in the ear responsible for hearing (the

cochlea) The major nerve pathway (8th cranial nerve) and/or area of

the brain responsible for hearing

Causes  Causes of conductive hearing loss

include: Impacted ear wax Fluid in the middle ear Ear infections Perforation of ear drum Stiff bones in the middle ear (

otosclerosis ) Injury Loose or fractured bones in the middle

ear

Missing bones from the middle ear due to previous surgery

Congenital anomaly causing complete closure of the ear canal (Atresia)

Tumors Causes of sensorineural hearing loss

include: Excess noise Aging Family history

Exposure to toxic substances, including such drugs as: Streptomycin Gentamicin Chemotherapy drugs Diuretics Steroids Heart medicines Anesthetics Quinine Aspirin-containing drugs

Acoustic neuroma

Cardiovascular disease Multiple sclerosis Viruses ( measles , mumps ,

adenovirus , rubella ) History of meningitis or syphilis Neurologic diseases such as

multiple sclerosis and stroke Inner ear disorders such as

Meniere’s disease Otosclerosis affecting the inner ear Previous brain or ear surgery

causing damage to the inner ear Trauma

Risk Factors  Risk factors for hearing loss include:

Family history Aging Meniere's disease Not receiving all recommended immunizations Repeated or poorly treated ear infections Exposure to loud noise, music, or machinery Use of certain antibiotics and chemotherapy drugs Diseases that may result in blocked blood flow, including

atherosclerosis , problems with blood clots, and collagen vascular diseases

Symptoms  Symptoms may include: Decreased ability to hear any of the following:

Higher pitched sounds Lower pitched sounds All sounds Speech when there is background noise

Dizziness Ringing sounds in the ears Problems with balance In children, hearing loss may cause difficulty learning to speak.

Diagnosis  The doctor will ask about your symptoms and medical history, and

perform a physical exam. Tests may include: Weber test—a tuning fork sounded and placed on your forehead or

teeth. This can help distinguish conductive from sensorineural hearing loss.

Rinne test—a tuning fork sounded and placed in front and then behind of the ear. This can help distinguish conductive from sensorineural hearing loss.

Audiometric tests —These involve listening to tones in a soundproof room and reporting whether or not you hear the tones.

Diagnosis  Tympanometry—This test measures the pressure in the middle

ear and examines the middle ear's response to pressure waves. CT or MRI scan of the head —a type of imaging study that uses

a computer to make pictures of the inside of the head. This may be done to check for a tumor or bone injury.

Brain stem auditory evoked responses—electrodes attached to the scalp and used to measure the electrical response of the brain to sound

Electrocochleography—This tests the cochlea and the auditory nerve.

Treatment  Treatment includes:

Earwax Removal  This is probably the simplest, easiest

treatment for hearing loss. Hearing Aids 

There are many types. Digital technology has created tiny devices that cause little distortion.

Devices  One example of a device is the FM trainer. With

this device, a person speaks into a microphone. The sound is then transmitted by radio waves directly to the earphone set worn on your ear. This can be particularly helpful if you have trouble hearing speech when there is background noise. FM trainers can also help children with hearing loss to understand their teachers.

Cochlear Implant  The cochlear implant is surgically implanted. It

directly stimulates part of the brain and uses a tiny computer microprocessor to sort out incoming sound.

Treat Other Medical Illnesses  When hearing loss is caused by other medical

conditions, it may be possible to improve hearing by treating those conditions.

Discontinue or Change Medications  If your hearing loss may be caused or worsened by a

medication, talk to your doctor about stopping that particular drug or changing to a drug that doesn't affect hearing.

Address Nutritional Deficiencies  It may be possible to slow age-related hearing loss in

elderly persons through dietary modification. For example, if you are deficient in folic acid , this supplement may be helpful for you. Talk to your doctor.

Surgery  Surgery may be done in some cases of

conductive hearing loss to correct the middle ear problem, such as in otosclerosis , ossicular damage or fixation, and ear infections.

Prevention  To help prevent hearing loss: Stop smoking. Adequately treat ear infections. Get all appropriate immunizations. Treat all medical conditions. Avoid exposure to excess noise. Use adequate ear protection when using noisy

equipment.

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Respiratory System Disorders of the Older Adult

Chronic Obstructive Pulmonary Disease 

Definition  Chronic obstructive pulmonary disease (COPD) makes it

difficult to push air out of the lungs. The oxygen-poor air will build up. If the lungs are filled with this air, there is no room for fresh, oxygen-rich air. COPD includes:

Emphysema —air sacs of lungs are damaged Chronic bronchitis —disorder of the large airways of lungs The changes to lung tissue differ with the two diseases.

However, the causes and treatment are similar.

Normal and Emphysemic Lung 

Causes  COPD develops due to: Cigarette smoking Inhaling toxins or other irritants Genetic predisposition can make a person's

lungs more susceptible to damage from smoke or pollutants (includes alpha-1-antitrypsin deficiency)

Risk Factors  Factors that increase your chance of developing COPD

include: Smoking cigarettes Long-term exposure to second-hand or passive smoke Family members with COPD Exposure to pollutants History of frequent childhood lung infections Age: 50 or older

Symptoms  Early symptoms of COPD include:

Coughing in the morning Coughing up clear sputum (mucus from deep in

the lungs) Wheezing Shortness of breath with activity

As the disease progresses, symptoms may include: Increased shortness of breath Choking sensation when lying flat Fatigue Trouble concentrating Heart problems Weight loss Breathing through pursed lips Desire to lean forward to improve breathing More frequent flare-ups (periods of more severe symptoms)

Diagnosis  Tests may include:

Chest x-ray —x-rays of the chest that may detect signs of lung infection

CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest

Blood tests—to assess the amount of oxygen and carbon dioxide in the blood

Lung function tests

Treatment  There is no treatment to cure COPD.

Treatment aims to ease symptoms and improve quality of life.

Smoking Cessation  Quitting smoking slows the disease.

Doctors consider it the most important part of treatment. Smoking cessation programs may include behavior modification and medicines to help you quit.

Environmental Management  Limit the number of irritants in the air you

breathe. It may help make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes.

Medication  Some may be taken by mouth. Nebulizers and inhalers deliver

drugs directly to the lungs. Drugs for COPD may work in the following ways: Opening the airways Relaxing the breathing passages Decreasing inflammation Helping thin secretions and bring up mucus from the lungs Treating lung infections (antibiotics): If you have chronic bronchitis and

mild-to-moderate COPD, you may not need antibiotics. If you do need them, a study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days).

Vaccines  Get vaccinated against pneumonia and the

flu . The flu vaccine may reduce COPD flare-ups.

Oxygen  It is given to improve the air you breathe in.

It increases the amount of available oxygen. This can increase energy levels and heart and brain function.

Exercise  Special exercises can strengthen chest muscles and make

breathing easier. Physical activity builds endurance and improves quality of life. Yoga is an example of an exercise routine that may offer benefits for people with COPD.

Breathing and Coughing Techniques  Special methods of breathing can help bring more air into

and force trapped air out of the lungs. Coughing helps clear the lungs of mucus.

Nutrition  Maintain a normal weight. Excess weight causes the lungs

and heart to work harder. Eat a healthy diet that is low in saturated fat and rich in

fruits, vegetables, and whole grain foods. Eat several small meals during the day. It makes breathing

easier. Avoid gas-producing foods. Large meals and excess gas

swell the stomach, which pushes up on the diaphragm. Drink fluids to keep mucus thin.

Lifestyle Changes  Pace your activities. Learn relaxation techniques and other methods to manage

stress. Seek emotional support from professionals, family, and

friends. Anxiety can increase the rate of respiration, making breathing more strenuous.

Surgery  A small number of patients may benefit from surgery.

(Lobectoy)

Prevention  Take these steps to reduce chance of

developing COPD: If you smoke, quit. Avoid exposure to second-hand smoke. Avoid exposure to air pollution or irritants. Wear protective gear if exposed to irritants or

toxins at work.

Common Cold 

Definition  The common cold is an infection that can

irritate your upper respiratory tract (nose and throat).

Sore Throat Due to Inflammation 

Causes  The common cold is caused by a virus. There are over 200

different viruses that can cause a cold, including: Rhinovirus Corona virus Adenovirus Coxsackie virus Paramyxovirus Parainfluenza virus Respiratory syncytial virus

Risk Factors  Risk factors for a cold are:

Being near someone who has a cold Touching your nose, mouth, or eyes with contaminated

fingers Having allergies (lengthens duration of cold) Smoking or being near cigarette smoke (due to

decreased resistance) Stress (due to decreased resistance)

Symptoms  Symptoms include:

Sore or scratchy throat Stuffy nose (hard to

breathe through your nose) Runny nose Sneezing Itchy, stuffed sensation in

the ears

Watery eyes Slight cough Headache Aches and pains Low energy Low-grade fever

Diagnosis  Your doctor will ask about your symptoms

and medical history. A physical exam will be done.

Treatment  A cold usually lasts more than 10 days.

There are no cures for a cold. But there are treatments that can relieve your symptoms, including:

Pain Relievers  You can take these for aches and pains, as well as

fever: Acetaminophen (Tylenol) Ibuprofen (Motrin)

Aspirin (Not recommended for viral Infections)

Decongestants  Pills or nasal sprays can shrink nasal passages and

decrease mucus production. Nasal sprays should only be used for 2-3 days. If used longer, increased congestion may occur when treatment is stoped OTC cough and cold products include:

Decongestants Expectorants Antihistamines Antitussives (cough suppressants)

Fluids  Drinks lots of fluids. Warm beverages, like tea, and

chicken soup are soothing and help reduce congestion. Humidifier 

A cool-mist humidifier can keep your nasal passages moist and reduce congestion. Be sure to clean the humidifier every day.

Saline Nasal Sprays  Saline nasal sprays may provide relief from congestion.

Alternative Treatments  Examples of alternative treatments include:

Vitamin C —Some people take vitamin C at the start of a cold, hoping that it will reduce symptoms and shorten how long the cold lasts. But, there is not a lot of evidence to support this. Taking vitamin C every day, though, may help to shorten a cold.

Zinc lozenges—People who take zinc at the start of a cold may have reduced symptoms. Echinacea —Echinacea may help people to recover faster from a cold. Pelargonium sidoides —This herb may improve symptoms and speed recovery. It is the

main ingredient in products like Umcka ColdCare and Zucol. Honey —Honey appears to improve nighttime cough and sleep disruption in children. Do

not give honey to infants younger than 12 months because of the risk of infant botulism .

For most herbs, doctors do not yet know if they work. Also, some herbal treatments may not be pure.

Salt Water Gargle  Gargling with warm salt water can help

relieve a sore throat. Over-the-Counter Cough Drops 

Using throat lozenges as needed every couple of hours can help relieve sore throat and cough.

Prevention  The most important way to keep from getting or spreading

a cold is by washing your hands. Wash your hands well and often. Other ways to keep from getting a cold:

Keep your hands away from your nose, mouth, and eyes. Stay away from people who have a cold. If you smoke, stop or cut down on smoking. Some people take vitamin C to keep from getting a cold.

But, doctors are not yet sure if vitamin C works.

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Genetourinary System disorders of the Older Adults

Prostate Cancer 

Cancer occurs when cells in the body (in this case prostate cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

The sooner prostate cancer is treated, the better the outcome. Call your doctor right away if you think you have this condition.

Prostate Cancer 

Causes  The cause of prostate cancer is unknown.

However, research shows that certain risk factors are linked to the disease.

Risk Factors  Age: 55 or older Race: Black Family history of prostate cancer, especially

father or brother Family history of prostate cancer diagnosed at a

young age A high-fat diet

Symptoms  A need to urinate frequently, especially at night Difficulty starting urination or holding back urine Not able to urinate Weak or interrupted urine flow Painful or burning urination Difficulty having an erection Painful ejaculation Blood in urine or semen Frequent pain or stiffness in the lower back, hips, or upper thighs

Diagnosis  Digital rectal exam—examination of the rectum with the doctor's gloved finger

inserted into your rectum Urine test—to check for blood or infection Blood test—to measure prostate specific antigen (PSA) and prostatic acid

phosphatase (PAP) Other tests to learn more about the cause of your symptoms are:

Transrectal ultrasonography—a test that uses sound waves and a probe inserted into the rectum to find tumors

Intravenous pyelogram —series of x-rays of the organs of the urinary tract Cystoscopy —the doctor looks into the urethra and bladder through a thin,

lighted tube Biopsy —removal of a sample of prostate tissue to test for cancer cells

Treatment  Once prostate cancer is found, tests are done

to find out if the cancer has spread and, if so, to what extent. Treatment depends on how far the cancer has spread. Talk to a radiation oncologist and urologist. They can help you decide the best treatment plan. Discuss the benefits and risks of each treatment option.

Watchful Waiting  There is no treatment with watchful waiting. Your

doctor will do tests to see if the cancer is growing. Watchful waiting is for: Early stage prostate cancer that seems to be growing

slowly Older prostate cancer patients or those with serious

medical problems that may make the treatment risks outweigh the possible benefits

Surgery  Surgery involves removing the

cancerous tumor and nearby tissues, and possibly nearby lymph nodes. Surgery is offered to patients who are in good health and are younger than 70 years old.

Types of surgery: Pelvic lymphadenectomy—removal of lymph nodes in the pelvis

to determine if they contain cancer If they do, removal of the prostate and other treatment may be

recommended. Radical retropubic prostatectomy —removal of the entire prostate

and nearby lymph nodes through an incision in the abdomen Radical perineal prostatectomy —removal of the entire prostate

through an incision between the scrotum and the anus Nearby lymph nodes are sometimes removed through a separate

incision in the abdomen.

Transurethral resection of the prostate (TURP) —removal of part of the prostate with an instrument inserted through the urethra TURP is not a cancer surgery, but can be used to relieve the symptoms if

you have either prostate cancer or an enlarged gland due to other reasons.

Prostate cancer surgery can cause impotence . It can also cause leakage of urine from the bladder or stool from the rectum. Nerve-sparing surgery may reduce these risks. But this kind of surgery may not effectively treat very large tumors or tumors that are very close to nerves.

Robotic surgery and laparoscopic surgery may be other options. These minimally invasive techniques can reduce side effects, blood loss, and recovery time.

Radiation Therapy  Radiation therapy involves the use of radiation to kill cancer cells

and shrink tumors. Radiation may be: External radiation therapy—radiation is directed at the tumor from a

source outside the body Internal radiation therapy—radioactive materials placed into the body near

the cancer cells Internal radiation therapy is often used for treating earlier stage cancers.

Radiation therapy for prostate cancer may cause impotence, urinary problems, and bowel problems. Most studies show that impotence rates are less for radiation therapy than for standard prostatectomy and slightly less than that for nerve-sparing procedures. Rates of incontinence following radiation therapy are also less than following prostatectomy. But, there is an increased risk of cystitis due to radiation.

Hormone Therapy  Hormone therapy is used for patients whose

prostate cancer has spread beyond the prostate or has recurred after treatment. The goal of hormone therapy is to lower levels of the male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancers to shrink or grow more slowly, but does not cure cancer.

Methods of hormone therapy include: Orchiectomy—a surgical procedure to remove one or

both of the testicles, which are the main source of male hormones Orchiectomy decreases hormone production. This can shrink

or slow the growth of most prostate cancers. Luteinizing hormone-releasing hormone (LHRH)

agonists—injections that can decrease the amount of testosterone made by the testicles

Anti-androgens (eg, flutamide , bicalutamide )—medications that can block the action of androgens These medications are used in combination with orchiectomy or

LHRH agonists, a combination called total androgen blockade. Drugs that prevent adrenal glands from making

androgens (eg, ketoconazole , aminoglutethimide ) Estrogens—drugs that prevent the production of

testosterone in the testicles Estrogens are rarely used today because of the risk of serious

side effects.

Hormone therapy for prostate cancer may cause: Hot flashes Impaired sexual function Loss of sexual desire Weakened bones

Other Treatment Options  Other treatments are being tested. Patients may want to consider taking part

in a clinical trial when weighing treatment options. The treatments that are currently being tested include:

Cryosurgery  Cryosurgery uses an instrument to freeze and destroy prostate cancer cells.

Chemotherapy  Chemotherapy is the use of drugs to kill cancer cells. It may be given in many

forms, including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells, but also some healthy cells.

One type of chemotherapy is docetaxel (Taxotere). This drug was found to prolong life in men with hormone refractory prostate (HRPC) cancer. (In HRPC, PSA levels continue to rise or the tumor continues to grow despite hormone therapy.)

Biological Therapy  Biological therapy is the use of medications or substances made by the body to

increase or restore the body’s natural defenses against cancer. It is also called biological response modifier (BRM) therapy.

High-intensity Focused Ultrasound  This treatment uses an endorectal probe that makes ultrasound (high-energy sound

waves). This can destroy cancer cells. Conformal Radiation Therapy 

Conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.

Intensity-Modulated Radiation Therapy (IMRT)  IMRT uses radiation beams of different intensities to deliver higher doses of radiation

therapy to the tumor and lower doses to nearby tissues at the same time.

Prevention  Talk to doctors about screening. Starting at age 50, Eat a healthy diet. Diet should be high in

fruits, vegetables and fish, and low in red meat. Ask the doctor about taking certain medicines. Daily

aspirin therapy and 5-alpha reductase inhibitors (eg, finasteride [Proscar, Propecia], dutasteride [Avodart]) may reduce your risk of prostate cancer.

Impotence 

Definition  Impotence is the inability to attain or

maintain an erection of the penis that is firm enough for sexual intercourse.

Causes  To initiate and maintain an erection, the

penis must fill with blood. Nerve signals cause the blood to flow there. The blood vessels expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

The following factors can cause erectile dysfunction: Venous Leak 

A leak in the blood vessels in the penis can allow blood to escape. This means that an erection cannot be made or may not last long. Injury or disease can cause a venous leak.

Neurovascular Function  Problems with nerve signals and blood flow Nerve dysfunction—can reduce feeling in the penis, resulting in impotence Diabetes —interferes with nerve signals Complete loss of nighttime erections Hardening of the arteries —can cause reduced blood flow Peripheral neuropathy , spinal cord injury, and surgery—can damage nerves Side-effects from medications

Blood Vessels and Nerves of Male Pelvis 

Psychological Factors  The brain causes many of the nerve signals

needed for an erection. Emotional problems may play a role in men who suddenly develop impotence.

Risk Factors  These factors increase your

chance of developing impotence. Tell your doctor if you have any of these risk factors:

Age: 65 and older Race: Hispanic Obesity Medical conditions:

Diabetes Hardening of arteries

Chronic kidney disease Liver failure Peyronie's disease (bending of

the penis caused by scar tissue) Endocrine disorders Neurological disorders (eg, 

multiple sclerosis , peripheral neuropathy , stroke )

Hypertension Psychiatric disorders (eg, anxiety

 , depression )

Traumatic conditions: Vascular surgery Pelvic surgeries

(particularly for prostate cancer )

Spinal cord injury Behaviors:

Alcohol use Illegal drug use Anabolic steroid use

Heavy smoking Interpersonal conflicts

with a sexual partner Medications:

Antihypertensives Antihistamines Antidepressants Tranquilizers Antipsychotics

Symptoms  Symptoms include: A less firm penis Fewer erections

Diagnosis  The doctor will ask about your symptoms and medical history,

and perform a physical exam. Expect questions about the frequency, quality, and duration of your erections. Your answers may help the diagnosis.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, you will need lab tests, including:

Hormone levels such as thyroid function tests Prolactin levels Testosterone levels

Nocturnal Penile Tumescence Testing  This test can help your doctor determine if the

cause is due to emotional problems or physical problems.

Imaging  Sometimes Doppler imaging may be done to look at

the blood flow. The test is also done to check for blockage in the arteries or veins that supply the penis.

Treatment  Treatment options include:

Medications  Your doctor may prescribe: Phosphodiesterase inhibitors, such as:

Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Do not take these medications if you are also taking nitrates.

Oral testosterone , if you have low testosterone levels Alprostadil , either injected into the penis or inserted into the urethra as a

suppository Use caution and talk to your doctor before taking any over-the-counter

medicines for impotence. Some of them may be unsafe. 

Vacuum Devices  Plastic cylinder for the penis Hand pump for pumping air out of the cylinder Elastic band for holding the erection after removal of the cylinder

Vascular Surgery  Vascular surgery repairs venous leaks. This has been shown to

be effective in some cases. Penile Implants 

There are semi-rigid, malleable, and inflatable implants. They are surgically inserted into the penis.

Penile Implant 

Sex Therapy  Sex therapy may help impotence resulting

from: Ineffective sexual techniques Relationship problems Anxiety Depression

Prevention  To reduce your chance of becoming impotent: Take medications to manage blood pressure , diabetes, or

depression. Ask your doctor about changing medications. Maintain a healthy weight . Eat a healthful diet . If you smoke, quit . Smoking is significantly associated with

impotence in middle-aged and older men. Talk to a therapist or counselor.

Menopause 

Definition  Menopause is the time when the menstrual

period ceases and the ovaries permanently stop releasing eggs. Menopause is considered complete when a woman has been without her period for a full year. Although menopause can occur anytime between ages 40 to 58, the average age is 51 years old.

Causes  Natural menopause is a gradual process. The ovaries begin producing lower

amounts of estrogen and other steroid hormones prior to menopause during a phase called perimenopause.

When menopause occurs before the age of 40 it is called premature menopause. Premature menopause can occur naturally but may also be the result of several conditions, including:

Family history of premature menopause Autoimmune diseases X-chromosome abnormalities Medical treatments (pelvic surgery, surgical removal of ovaries, 

chemotherapy , or pelvic radiation therapy) Medications that lower estrogen levels Smoking

Symptoms  As menopause approaches, women

often experience a number of physical and emotional symptoms including:

Irregular menstrual periods Hot flashes and night sweats Disturbed sleep patterns, insomnia Anxiety Significant mood changes Depression Dry skin Irritability

Vaginal dryness and pain with sexual intercourse

Difficulty concentrating Trouble remembering things Diminished interest in sex Frequent urination or leaking of

urine Headaches Achy joints Fatigue Early morning awakening

Diagnosis  Natural menopause is usually diagnosed when a woman

has not had a menstrual period for 12 consecutive months. Some women have had a hysterectomy before

menopause, and they no longer have periods. For these women, if menopause is suspected but needs confirmation, the test considered most accurate for the diagnosis of menopause is the measurement of follicle stimulating hormone (FSH) . High levels of FSH (greater than 40) may indicate menopause.

Treatment  Menopause is a natural part of life and does

not necessarily require treatment. Symptoms and health risks associated with low estrogen can be treated. These include hot flashes, vaginal dryness, and osteoporosis (loss of bone mass).

Osteoporosis in Hip 

Hormone Replacement Therapy (HRT)  A number of different types of hormones are available. They include: Natural, synthetic, and plant-derived estrogens Progesterone Combinations of estrogen and progesterone Addition of small amounts of male hormones HRT is available as tablets, gels, skin patches, vaginal rings, vaginal

tablets, injections, and pellets inserted into the skin. There are a number of possible risks associated with HRT . Some of

these include cancer (endometrial , breast , ovarian ), heart disease, gallstones , and gastroesophageal reflux disease(GERD).

Phytoestrogens  A high intake of phytoestrogens (or plant

estrogens) may help menopausal women. They may reduce the risk for diseases associated with estrogen. Phytoestrogens are found in soybeans, black cohosh , rhubarb extract (a supplement), whole grains, legumes, tempeh, and flax seed. They are also found in concentration in capsule form.

Healthful Diet  A healthful diet during menopause can improve a woman's sense of

well-being. It may also reduce the risk of heart disease, osteoporosis, and certain cancers. The diet should be low in fat and high in fruits, vegetables, whole grains, calcium , and vitamin D .

Limit Caffeine and Alcohol  Cutting back on caffeine and alcohol may reduce symptoms of

anxiety, insomnia, and loss of calcium. Quit Smoking 

Giving up smoking can reduce the risk of early menopause, heart disease, and osteoporosis.

Regular Exercise  Regular exercise may reduce hot flashes. Weight-bearing exercises

 such as walking, climbing stairs, and resistance exercises such as lifting weights help strengthen bones and decrease the risk of osteoporosis.

Stress Management  Stress management may help ease tension, anxiety, and possibly

other menopausal symptoms. Deep breathing, massage , warm baths, and quiet music are examples of relaxation techniques.

Over-the-Counter Products  Moisturizers and lubricants are used to help vaginal dryness.

Nonhormonal Medications for Hot Flashes  Certain blood pressure medicines (taken in lower doses)

Examples include: clonidine (Catapres), methyldopa (Aldomet) Selective serotonin reuptake inhibitors (SSRIs) and

serotonin and norepinephrine reuptake inhibitors (SNRIs) Examples include: fluoxetine (Prozac), paroxetine (Paxil), 

venlafaxine (Effexor),desvenlafaxine (Pristiq) Note: SSRIs and SNRIs should not be used if you are taking 

tamoxifen (Nolvadex), a medication to reduce the risk of breast cancer recurrence.

Prevention  Menopause is a natural biologic event that

does not need to be prevented. Quitting smoking could slightly delay the onset of menopause.

Urinary Incontinence—Female 

Definition  Urinary incontinence is the loss of voluntary

bladder control leading to urine leakage. It can be temporary or chronic (lasting for a long time). Incontinence is a symptom, not a condition in and of itself.

Causes  Temporary incontinence can be caused by:

Medicines Constipation Infection Muscle weakness Restricted mobility Obesity Endocrinological disorders (for example, diabetes )

Stress Incontinence  This results when certain activities lead to increased

pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects , or exercise. This is the most common type of incontinence. It may be caused by:

Weakening of the muscles that suspend the bladder Weakening of muscles that control urine flow Obesity

Muscles Involved in Incontinence in Women 

Urge Incontinence  Urge incontinence is a loss of bladder

control following a strong urge to urinate. The person is not able to hold urine long enough to make it to a restroom. This is also known as overactive bladder.

It may be caused or worsened by: Urinary tract infection Diabetes type 1 and 2 Bladder irritation (stone,

tumor) Drugs (eg, hypnotics,

diuretics) Caffeine

Alcohol Nerve damage due to:

Spinal cord injury Stroke Multiple sclerosis Parkinson's disease

Constipation

Overflow Incontinence  This occurs when the bladder will not

empty. Urine builds up, and this causes an overflow and leaking of urine

It may be caused by: A bladder that is blocked, such as by a scar in the urethra (stricture) Fecal impaction Drugs (eg, antidepressants, hypnotics, antipsychotics, antihistamines,

calcium channel blockers) Vitamin B12 deficiency Weak bladder muscles Nerve damage due to:

Surgery Diabetes Spinal cord injuries Other factors

Functional Incontinence  This occurs when there is normal bladder

control, but an inability to reach the toilet in time. An example would be severe arthritis . Drugs that cause confusion or sedation can also cause functional incontinence.

Risk Factors  Age: older than 65 Having been pregnant multiple times or

having a comlicated delivery Urinary tract infection Obesity Chronic lung disease Urethritis Previous hysterectomy or urethral

surgery Pelvic organ prolapse Depression Dementia including Alzheimer’s disease

Menopause Diabetes Stroke Multiple sclerosis Spinal cord injury or disease Use of certain substances/medicines:

Caffeine Alcohol Alpha-agonists Cholinergic agents Cyclophosphamide

Symptoms  Urinary incontinence is a symptom of other

conditions. Any loss of bladder control can be considered incontinence.

Diagnosis  Tests may include:

Stress test—You relax then cough as your doctor watches for loss of urine. This will confirm if you have stress incontinence.

Urine tests Blood tests to detect diabetes Ultrasound —a test that uses sound waves to examine structures inside

the body to determine the residual urine volume after voiding Cystoscopy—a thin tube with a tiny camera is inserted in the urethra to

view the urethra and bladder Urodynamic tests—tests used to measure the flow of urine and pressure

in the bladder

Treatment  Treatments may include:

Behavioral Therapy  Behavioral therapy includes: Making muscles stronger by doing Kegel exercises

This strengthens the muscles that hold the bladder in place and those that control urine flow.

Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence.

Bladder training This can be done by setting a regular, timed schedule for emptying your bladder and by

drinking fewer liquids. Weight Loss  If you are a woman who is overweight or obese, losing weight may help to reduce the

number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.

Medication  Medicines may be prescribed to relax the bladder

muscles. These types of medicines, called anticholinergics, are often used in treating urge incontinence. Examples include: Oxybutynin (Ditropan) Tolterodine (Detrol) Darifenacin (Enablex) Solifenacin (Vesicare)

Nerve Stimulation  Nerve stimulation is effective for urge urinary incontinence. It can be done by

stimulating a nerve in your ankle. Or, it can be done by implanting a device that stimulates the bladder nerves.

Surgery  In women, surgery can support weakened muscles related to bladder

function. Other procedures involve collagen injections into the urethra. Devices 

Absorbent diapers are often used with incontinence. Plugs and patches that hold urine in place are available for women. Catheters

are sometimes used to treat more severe cases. Alternatively, pessaries may be used in women. Pessaries are devices that raise the uterus or the prolapsed bladder. This decreases pressure on the bladder.

Prevention  Incontinence is really a symptom of another condition.

There are several ways to prevent incontinence: do Kegel exercises. Reduce intake of substances that lead to incontinence

(eg, caffeine, alcohol, and certain drugs). Lose weight. Eat a healthy diet to avoid constipation.

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Cardiovascular System Disorders of the Older Adults

Coronary Artery Disease 

Definition  Coronary arteries bring oxygen rich blood to the heart

muscle. Coronary artery disease (CAD) is blockage of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In severe case the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI).

Coronary artery disease is the most common form of heart disease. It is the leading cause of death worldwide.

Coronary Artery Disease 

Causes  Causes include:

Thickening of the walls of the arteries feeding the heart muscle

Accumulation of fatty plaques within the coronary arteries Sudden spasm of a coronary artery Narrowing of the coronary arteries Inflammation within the coronary arteries Development of a blood clot within the coronary arteries that

blocks blood flow

Risk Factors  Major risk factors include:

Sex: male (men have a greater risk of heart attack than women) Age: 45 and older for men, 55 and older for women Heredity: strong family history of heart disease Obesity and being overweight Smoking High blood pressure Sedentary lifestyle—Poor fitness can also increase your risk of CAD and premature

death. High cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol) Diabetes Metabolic syndrome (combination of high blood pressure, abdominal obesity, and

insulin resistance)

Other risk factors may include: Stress Excessive alcohol use Depression A diet that is high in saturated fat, trans fat,

cholesterol, and/or calories— Drinking sugary beverages on a regular basis may increase your risk of CAD.

Symptoms  CAD may progress without any symptoms.

Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:

Exercise or exertion Emotional stress Cold weather A large meal

Chest pain may indicate more serious unstable angina or a heart attack if: It is unrelieved by rest or nitroglycerin Severe angina Angina that begins at rest (with no activity) Angina that lasts more than 15 minutes Accompanying symptoms may include:

Shortness of breath Sweating Nausea Weakness

Immediate medical attention is needed for unstable angina. CAD in women may cause less classic chest pain. It is likely to start with shortness of breath and fatigue.

Diagnosis  Tests may include:

Blood tests—to look for certain substances in the blood called troponins which help the doctor determine if you are having a heart attack

Electrocardiogram (ECG, EKG)— records the heart's activity by measuring electrical currents through the heart muscle, and can reveal evidence of past heart attacks, acute heart attacks, and heart rhythm problems

Echocardiogram —uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart, giving information about the structure and function of the heart

Exercise stress test —records the heart's electrical activity during increased physical activity

Nuclear stress test—the heart is observed while exercising and radioactive material highlights impaired blood flow to help locate problem areas

Coronary calcium scoring—a type of x-ray called a CAT scan that uses a computer to look for the presence of calcium in the heart arteries

Coronary angiography —x-rays taken after a dye is injected into the arteries to allows the doctor to look for abnormalities in the arteries

Treatment  Treatment may include:

Nitroglycerin  This medicine is usually given during an attack of angina. It can be given as

a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments.

Blood-Thinning Medications  A small, daily dose of aspirin has been shown to decrease the risk of heart

attack. Ask your doctor before taking aspirin daily. Warfarin (Coumadin) Ticlopidine (Ticlid) Clopidogrel (Plavix)

Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors 

These may help prevent angina. In some cases, they may lower the risk of heart attack.

Medications to Lower Cholesterol  Medicines, like statins, are often prescribed to

people who have CAD. Statins (eg, atorvastatin [Lipitor]) lower cholesterol levels, which can help to prevent CAD events.

Revascularization  Patients with severe blockages in their coronary arteries may benefit

from procedures to immediately improve blood flow to the heart muscle: Percutaneous coronary interventions (PCI)—such as balloon angioplasty

, in some cases, a wire mesh stent is placed to hold the artery open Coronary artery bypass grafting (CABG) —segments of vessels are taken

from other areas of the body and are sewn into the heart arteries to reroute blood flow around blockages

Some studies have shown that CABG may be more effective than PCI. Lifestyle changes and intensive medicine may also be just as effective as PCI.

Options for Refractory Angina  For patients who are not candidates for revascularization procedures

but have continued angina despite medicine, options include: Enhanced external counterpulsation (EECP)—large air bags are

inflated around the legs in tune with the heart beat. The patient receives 5 one-hour treatments per week for seven weeks. This has been shown to reduce angina and may improve symptom-free exercise duration.

Transmyocardial revascularization (TMR)—surgical procedure done with laser to reduce chest pain.

Researchers are also studying gene therapy as a possible treatment.

Prevention  To reduce your risk of getting coronary artery disease: Maintain a healthy weight. Eat a heart healthy diet that is low in saturated fat , red meat and

processed meats, and rich in whole grains , fruits, and vegetables . Begin a safe exercise program with the advice of your doctor. If you smoke, quit . Treat your high blood pressure and/or diabetes. Treat high cholesterol or triglycerides. Ask your doctor about taking a low-dose aspirin every day. In certain patients, taking rosuvastatin (Crestor) may be another option.

Talk to your doctor.

Heart Attack 

Definition  A heart attack occurs when blood flow to

the heart muscle is interrupted. Oxygen can't get to the heart muscle, causing tissue damage or tissue death.

Heart Attack (Myocaedial Infarction)

Causes  A heart attack may be caused by: Thickening of the walls of the arteries feeding the heart

muscle (coronary arteries) Accumulation of fatty plaques in the coronary arteries Narrowing of the coronary arteries Spasm of the coronary arteries Development of a blood clot in the coronary arteries Embolism that affects the coronary arteries

Risk Factors  Sex: male Increased age Obesity Smoking High blood pressure Sedentary lifestyle High blood cholesterol

(specifically, high LDL cholesterol, and low HDL cholesterol)

High blood triglycerides Diabetes Stress Family members with

heart disease

Symptoms  Symptoms include:

Squeezing, heavy chest pain, especially with:

Exercise or exertion Emotional stress Cold weather A large meal

Pain in the left shoulder, left arm, or jaw

Shortness of breath Sweating, clammy skin Nausea Weakness Loss of consciousness Anxiety , especially feeling a

sense of doom or panic without apparent reason

Unusual symptoms of heart attack (may occur more frequently in women): Stomach pain Back and shoulder pain Confusion Fainting

Diagnosis  Tests may include:

Blood tests—to look for certain enzymes found in the blood within hours or days after a heart attack

Urine tests—to look for certain substances found in the urine within hours or days after a heart attack

Electrocardiogram (EKG) —records the heart's activity by measuring electrical currents through the heart muscle, changes can show if there is blockage or damage

Echocardiogram —uses high-frequency sound waves (ultrasound) to examine the size, shape, function, and motion of the heart

Stress test —records the heart's electrical activity under increased physical stress, usually done days or weeks after the heart attack

Nuclear scanning—uses radioactive material to show areas of the heart muscle where there is diminished blood flow

Electron-beam computed tomography (EBCT) —a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures; may be helpful if you are at immediate risk of coronary artery disease

Coronary angiography —uses dye and x-rays to look for narrowing or blockage in the coronary arteries

Treatment  Treatment includes:

Oxygen Pain-relief medications (such as morphine) Nitrate medications Aspirin and other antiplatelet agents

Beta-blocking and/or ACE inhibitor medications (frequently given)

Anti-anxiety medications Clot-dissolving agents (thrombolytics)—Within the first six

hours after a heart attack, you may be given medications to break up blood clots in the coronary arteries.

Other medicines that may be given include those that block the function of platelets (called platelet IIb/IIIa receptor blockers).

Cholesterol-lowering medications (eg, statin drugs)

Surgery  Surgery includes:

Coronary artery bypass grafting (CABG) Atherectomy Balloon angioplasty with or without stenting

According to a review, patients who received CABG had more angina relief and less need for another, similar procedure. This is compared to those who received percutaneous coronary intervention (PCI). PCI involves techniques using balloon angioplasty or coronary stenting .

Physical or Rehabilitative Therapy  During recovery , the client may need physical

or rehabilitative therapy to help him or her to regain his/her strength.

Treatment for Depression  Clients may feel depressed after having a

heart attack. Therapy and medication can help relieve depression .

Prevention  Preventing or treating coronary artery disease may help prevent a heart attack. Maintain a healthy weight . Begin a safe exercise program . Follow your doctor's advice. If you smoke, quit . Eat a healthful diet . Your diet should be low in saturated fat and rich in whole

grains, fruits, and vegetables. Treat high blood pressure , diabetes and high cholestrol . Manage stress .

Ask your doctor about taking a small, daily dose of aspirin. Although most people are able to tolerate such a low dose of aspirin, even this small

amount can rarely lead to serious bleeding, particularly from the gastrointestinal (GI) tract . Aspirin may not work as well when combined with other pain medications.

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Musculoskeletal System Problems of the Older Adult

Hip Fracture 

Definition  A hip fracture is a break in the thigh bone

just below the hip joint. The hip joint consists of a ball at the top of the thigh bone (femur) and a rounded socket (acetabulum) in the pelvis. Most hip fractures occur in the neck of the femur 1-2 inches below the ball portion of the hip.

Hip Fracture 

Causes  Factors that may contribute to a hip fracture include:

Falls (the most frequent cause of hip fractures) Osteoporosis —a bone-thinning condition that weakens

all bones including the hip Motor vehicle accidents and other types of major trauma Stress fractures in athletes (rare) Bone conditions such as osteomalacia (rare) Bone tumors (rare)

Risk Factors  Previous hip fracture or history of falling Age: 65 years or older Sex: female (especially after menopause) Heredity

Family history of fractures later in life Small-boned, slender body (low body weight) Caucasian or Asian race

Others: Poor nutrition Deficient intake or absorption of

calcium and vitamin D Low body weight Physical inactivity Weakness Poor balance and coordination Smoking Excessive alcohol use Chronic disease or fragile health Irregular heart beat or low blood

pressure

Arthritis Parkinson's disease History of stroke Mental impairments including

Alzheimer’s disease Problems with vision Certain medications which cause

dizziness, drowsiness, or weakness

Systemic cortisone or other steroids

Excess thyroid hormone

Symptoms  Symptoms may include:

Pain in the hip Difficulty or inability to stand, walk, or move the

hip Abnormal appearance of the broken leg:

Looks shorter Turns outward

Diagnosis  Tests may include:

X-ray —to determine exactly where the bone is broken and how far out of place the pieces have moved

Bone scan or MRI scan—used if the fracture doesn't show up on x-rays but symptoms indicate a fracture has occurred

Treatment  The goal is to get the client back on his feet again as quickly as

possible while his broken bone heals. For older patients, staying in bed for even several days may lead to serious complications.

Treatment includes: Prompt Emergency Treatment 

Taking all weight off the injured leg and immobilizing the fracture Checking vital signs such as blood pressure Treating problems such as internal blood loss Pain control with pain killers and other drugs

Surgery  Surgery is performed to set the broken bone and hold it in the correct

position. This may involve: Inserting a surgical plate and screws at the fracture site Replacing the hip with a metal implant (prosthesis), which has a ball

that fits into the hip socket and an attached stem which goes into the thigh bone to hold the implant in place

Physical Assistance  Exercises or therapy to help you return to your normal level of activity A cane or walker as advised by your doctor Aid with activities of daily living until you can return to normal activity

Prevention  Early corrective action may help alleviate many of the factors that can lead to a

hip fracture. Here's what you can do: Eat a diet with nutrients for strong bones:

Calcium —about 1000 milligrams daily but check with your doctor Vitamin D —400-800 units a day Adequate protein intake

Exercise: Weight-bearing activities such as walking Strengthening exercises for both upper and lower extremities

Preventive medication may include: Hormone replacement therapy for women after menopause Biphosphonates Calcitonin

Ask doctor if any of the client’s medications may contribute to: Bone loss Dizziness, drowsiness, or confusion

Reduce falling hazards at work and home: Clean spills and slippery areas immediately. Remove tripping hazards such as loose cords, rugs, and clutter. Use non-slip mats in the bathtub and shower. Install grab bars next to the toilet and in the shower or tub. Put in handrails on both sides of stairways. Walk only in well-lit rooms, stairs, and halls. Keep flashlights on hand in case of a power outage.

Get eyes checked regularly.

Osteoarthritis 

Definition  Osteoarthritis is the breakdown of cartilage in

the joints. This is followed by chronic inflammation of the joint lining. Healthy cartilage is a cushion between the bones in a joint. Osteoarthritis usually affects the hands, feet, spine, hips, and knees. People with osteoarthritis usually have joint pain and limited movement of the affected joint.

Joints Affected by Osteoarthritis 

Causes  Osteoarthritis is associated with aging. The

exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity. It is related to constant ware and tare of joints that comes with aging.

Risk Factors  Obesity Genetic factors Injury to the joint surface Occupations and physical activities that put

stress on joints Neuromuscular disorders, like diabetes

Symptoms  Symptoms include:

Mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time

Creaking or grating sound in the joint Swelling, stiffness, limited movement of the joint,

especially in the morning Weakness in muscles around the sore joint Deformity of the joint

Diagnosis  Tests may include:

X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones

Blood tests Arthrocentesis —a procedure that involves

withdrawing fluid from a joint

Treatment  There is no treatment that stops cartilage

loss or repairs cartilage that is damaged. The goal of treatment is to reduce joint pain and inflammation and to improve joint function.

Medications  Over-the-counter pain medicine

Acetaminophen (eg, Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg, Advil) and naproxen (eg, Aleve)

Prescription pain medicine Arthrotec —nonsteroidal anti-inflammatory drug; may reduce the risk

for gastrointestinal bleeding Opiates and opiate-like medications

Viscosupplementation—injection of a substance called hyaluronan into the joint, which helps lubricate the joint

Pain relief creams— capsaicin , methyl salicylate, and menthol

Dietary Supplements  There is some evidence that glucosamine and chondroitin may

relieve pain and/or decrease osteoarthritis progression. Talk with your doctor before taking any herbs and supplements.

Alternative Treatments  Some doctors report that acupuncture has been successful in

reducing the pain of osteoarthritis, although the evidence is not consistent.

While more studies are needed, balneotherapy (hot water therapy), relaxation therapy , exercise , yoga , and tai chi may be helpful.

Mechanical Aids  Shoes with shock-absorbing soles may provide some

relief while you are doing daily activities or exercising. Splints or braces help to properly align joints and distribute weight. Knee and wrist joints may benefit from elastic supports. A neck brace or corset may relieve back pain . Also, a firm mattress may help chronic back pain. Canes , crutches , walkers , and orthopedic shoes also can help those with advanced osteoarthritis in the lower body.

Weight Reduction  Losing weight can lessen the stress on joints affected by osteoarthritis. Losing

five pounds can eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the greater the benefit.

Exercise and Physical Therapy  Strengthening the muscles supporting an arthritic joint (particularly the knee,

lower back, and neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis in the knee, exercise, including strength training , can also help improve knee function.

Swimming and water aerobics are good options because they do not put stress on the joint.

Another option is transcutaneous electrical nerve stimulation (TENS). With TENS, you are connected to a machine that sends electrical signals through the skin to nerves. This type of therapy may decrease pain in some people.

Assist Devices  If you are having difficulty getting around due to arthritis pain, your doctor

might recommend that you install handrails and grips throughout your home. These are useful in the bathroom and shower. You may need elevated seats (including toilet seats) if you're having difficulty rising after sitting.

Heat and Ice  Applying heat (with hot water bottles or heating pads) helps joints and

muscles move more easily. It can also lessen pain. Using ice packs after activity can also help.

Steroids  Corticosteroid injections to the inflamed joint may be given if other pain

medicines do not work. Because repeated cortisone injections can be harmful to the cartilage, they are reserved for those with severe symptoms.

Surgery  Surgery can:

Reposition bones to redistribute stress on the joint

Replace joints Remove loose pieces of bone or cartilage from

joints

Prevention  To reduce chance of getting osteoarthritis:

Maintain a healthy weight. Do regular, gentle exercise (eg, walking, stretching,

swimming, yoga). Avoid repetitive motions and risky activities that may

contribute to joint injury, especially after age 40. With advancing age, certain activities may have to be

dropped or modified. But, continue to be active.

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Neurologic System Disorder s of the Older Adults

Alzheimer's Disease 

Definition  Alzheimer's disease is a progressive

condition that destroys brain cells. It is the most common cause of dementia . People with this disease slowly lose the ability to learn, function, and remember.

Areas of the Brain Affected by Alzheimer's Disease 

Causes  The cause is not yet known. Studies suggest that

two main mechanisms are involved with the development of Alzheimer's disease:

Plaques—abnormal deposits of a substance called beta amyloid in different areas of the brain

Neurofibrillary tangles—twisted fibers (called tau fibers) within nerve cells

Risk Factors  Factors that may increase your

chance of Alzheimer's disease include:

Age: 65 and older Previous serious, traumatic brain

injury Lower educational achievement Down's syndrome Down's syndrome in a first-

degree relative

Women under 35 who give birth to a child with Down's syndrome

Smoking Family history of Alzheimer's

disease Presence of a certain variety type

of protein (APOE-e4) Depression Elevated levels of homocysteine Heart disease

Researchers are studying the following to see if they are related to Alzheimer's disease: Poor nutrition and vitamin deficiency in childhood Excess metal in the blood, especially zinc, copper,

aluminum, and iron Certain viral infections Diabetes High Cholesterol

Symptoms  The disease begins as mild memory lapses. It moves to

profound loss of memory and function. Alzheimer's disease is divided into three stages: Early—memory and cognition loss are noticeable but still

able to function independently Intermediate—mental loss, personality changes more

dependent on others for basic needs Severe—loss of personality and bodily functions; total

dependence for care

Symptoms include: Increasing trouble remembering things, such as:

How to get to familiar locations What the names of family and friends are Where common objects are usually kept How to do simple math How to do usual tasks, such as cooking, dressing,

bathing, etc.

Having difficulty concentrating on tasks Having difficulty completing sentences due

to lost/forgotten words (may progress to complete inability to speak)

Forgetting the date, time of day, season Getting lost in familiar surroundings

Having mood swings Being withdrawn, losing interest in usual

activities Having personality changes Walking in a slow, shuffling way Having poor coordination Losing purposeful movement

Diagnosis  There are no tests to definitively diagnose this disease. The doctor will

ask about your symptoms and medical history. A physical exam will be done. The doctor will ask many questions. This will help to rule out other causes. Tests to rule out other medical conditions may include:

Neurological exam Psychological and mental status testing CT scan —a type of x-ray that uses a computer to make pictures of the brain MRI scan —a test that uses magnetic waves to make pictures of the brain Electroencephalogram (EEG) —a test that measures electrical currents in the brain Blood tests and urine tests Lumbar puncture —to test for levels of certain brain proteins that increase with

Alzheimer’s disease and to rule out other disorders PET scan of the brain—a test that makes images showing activity in the brain

Treatment  There is no cure for Alzheimer's disease. There are also no certain ways

to slow its progression. Four medicines have received approval for the treatment of some symptoms. Various drugs are being studied to see if they can manage the symptoms or slow the condition's course.

Medications for Symptoms and Disease Progression  Only two types of medicines have been approved to reduce the

symptoms of Alzheimer's disease: Cholinesterase inhibitors—approved and recommended for mild to

moderate Alzheimer's disease (eg, donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])

N-methyl-D-aspartate (NMDA) receptor antagonist—approved for moderate to severe Alzheimer's disease (eg, memantine )

Treatments that are being studied include: Gamma-secretase inhibitors Tau fiber aggregation inhibitors Herbs and supplements (eg, vitamin E ,

ginkgo biloba )—The evidence is mixed as to the effectiveness of these natural remedies.

Lifestyle Management  Managing the disease includes:

Creating an environment in which you can receive the care you need Optimizing your quality of life Keeping yourself safe Helping yourself learn to deal with the frustration of your uncontrollable

behavior Providing a calm, quiet, predictable environment Providing appropriate eyewear and hearing aids, easy-to-read clocks and

calendars Playing quiet music Light, appropriate exercise to reduce agitation and relieve depression Encouraging family and close friends to visit frequently

Psychiatric Medication  Psychiatric symptoms may occur with

Alzheimer’s disease. Doctors may prescribe medicine to treat: Depression Anxiety Confusion, paranoia, and hallucinations

Caregiver Support  Caring for a person with Alzheimer's

disease is extremely difficult and exhausting. The primary caregiver needs emotional support, as well as regular respite.

Prevention  There are no guidelines for preventing

Alzheimer's disease because the cause is unknown.

Depression 

Definition  Depression is a mental illness marked by feelings of

profound sadness and lack of interest in activities. Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes  The precise cause is not known. It can be difficult to determine if an

illness causes depression or depression caused the illness. Possible causes may be mental, physical, or environmental and include:

Stressful life events (usually in combination with one or more of the following causes)

Chronic stress Low self-esteem Imbalances in brain chemicals and hormones Lack of control over circumstances (helplessness and hopelessness) Negative thought patterns and beliefs Chronic pain

Heart disease and heart surgery Genetic predisposition Altered brain structure and function, including after a stroke Parkinson’s disease Postpartum depression occurs after childbirth Seasonal affective disorder (SAD) is a type of depression or a worsening

of symptoms thought to be due to the decreased exposure to sunlight that occurs during winter months

Hypothyroidism Anemia Cancer Substance abuse

Brain 

Researchers are studying how problems with synapses in the brain may be linked to depression.

Risk Factors  Risk factors include:

Sex: female Age: elderly Chronic physical or mental illness, including thyroid disease,

headaches, chronic pain, and stroke Previous episode of depression Major life changes or stressful life events (eg, bereavement, trauma

) Postpartum depression Winter season for SAD

Little or no social support Low self-esteem Lack of personal control over circumstances Family history of depression (parent or sibling) Feelings of helplessness Certain medicines, including medicines used to treat asthma ,

high blood pressure , arthritis, high cholesterol , and heart problems Smoking Anxiety Insomnia Personality disorders Hypothyroidism Type 2 diabetes

Symptoms  Depression can differ from person to

person. Some people have only a few symptoms, while others have many.

Symptoms can change over time and may include:

Persistent feelings of sadness, anxiety, or emptiness

Hopelessness Feeling guilty, worthless, or helpless Loss of interest in hobbies and

activities Loss of interest in sex Feeling tired

Trouble concentrating, remembering, or making decisions

Trouble sleeping, waking up too early, or oversleeping

Eating more or less than usual Weight gain or weight loss Thoughts of death or suicide with or

without suicide attempts Restlessness or irritability Physical symptoms that defy standard

diagnosis and do not respond well to medical treatments

Diagnosis  There is no blood test or diagnostic test for depression. The doctor will ask

about your symptoms and medical history, giving special attention to: Alcohol and drug use Thoughts of death or suicide Family members who have or have had depression Sleep patterns Previous episodes of depression

The doctor may also perform specific mental health exams. This will help get detailed information about your speech, thoughts, memory, and mood. A physical exam and other tests can help rule out other causes.

Treatment  Treatment may involve the use of medicine,

psychotherapy, or the use of both. Severe depression usually requires hospital care and the

use of drugs. Antidepressant Medications 

Up to 70% of depressed patients find relief from their symptoms with medicine. They can take 2-6 weeks to reach their maximum effectiveness. The medicines include:

Fluoxetine (eg, Prozac) Sertraline (eg, Zoloft) Paroxetine (eg, Paxil) Citalopram (eg, Celexa) Fluvoxamine (eg, Luvox) Escitalopram (eg,

Lexapro)

Imipramine (eg, Tofranil) Doxepin (eg, Adapin,

Sinequan) Clomipramine (eg,

Anafranil) Nortriptyline (eg,

Pamelor) Amitriptyline (eg, Elavil)

Selective Serotonin Reuptake Inhibitors (SSRIs)  Tricyclic Antidepressants 

Phenelzine (eg, Nardil)

Tranylcypromine (eg, Parnate)

Venlafaxine (eg, Effexor) Nefazodone (eg, Serzone) Mirtazapine (eg,

Remeron) Bupropion (eg,

Wellbutrin) Duloxetine (eg, Cymbalta)

Monoamine Oxidase Inhibitors (MAOIs) Other Antidepressants 

Psychotherapy  Short-term (10-20 weeks)

cognitive-behavior therapy (CBT) can help some people. Psychotherapy is designed to help you:

Cope with difficulties in relationships Change negative thinking and behavior patterns Resolve difficult feelings

Electroconvulsive Therapy (ECT)  ECT is the use of an electric stimulus to

produce a generalized seizure. It may be used in people with severe or life-threatening depression. ECT is also used for people who cannot take or do not respond to medicine. It is considered a safe and effective procedure.

Exercise  A regular exercise program has been shown to relieve some

of the symptoms. It should play a large role in the overall management of depression.

Bright Light Therapy  If you have SAD, your doctor may recommend bright light

therapy. This involves being exposed to high levels of light from a special "light box" that has a screen on it. Light therapy may decrease melatonin , a hormone that affects sleep cycles, and reduce symptoms of depression.

Dietary Supplements and Herbal Therapy  The herb St. John's wort may be an effective alternative

to standard medicines with fewer side effects. St. John's wort, though, may reduce the effectiveness of many drugs, such as antidepressants, birth control pills, blood thinners, and other medicines.

There is also some evidence that dehydroepiandrosterone (DHEA), a hormone that is available as a dietary supplement, may help some people.

Dietary Changes  Research suggests that diets high in tryptophan and

certain B vitamins may be helpful. There is also mixed evidence that fish oil may reduce symptoms.

If you want to take supplements or change your diet, talk to your doctor first.

Vagal Nerve Stimulation (VNS)  VNS is used as therapy for depression when multiple trials

of medicine do not work. A pacemaker-like device stimulates the vagus nerve in the neck.

Vagus Nerve 

Stimulation of the vagus nerve (yellow) at the neck is a depression therapy option.

Transcranial Magnetic Stimulation (TMS)  TMS is still under investigation, but seems

to have some issues in treatment-resistant depression. An electromagnetic coil is held against your forehead. The change in electrical field stimulates nerves, improving symptoms of depression.

Prevention  Being aware of your personal risk Having a psychiatric evaluation and psychotherapy if needed Developing social supports Learning stress management techniques Exercising regularly Not abusing alcohol or drugs Getting adequate sleep, rest, and recreation Eating a Mediterranean diet . This includes plant foods, olive

oil, and fish and chicken.

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Gastrointestinal Disorders of the Older Adults

Constipation 

Definition  Constipation is infrequent and/or

uncomfortable bowel movements. Stool is often hard and dry. It is the most common gastrointestinal complaint in the United States and accounts for 2 million annual visits to the doctor.

Causes  Constipation has many causes, including:

Not enough fluid intake Overuse of laxative medicines Too little exercise Bed rest

Certain medications, including: Pain relievers Narcotics Aluminum-containing antacids Antidepressant and antipsychotic medications Medications for epilepsy and Parkinson's disease Antispasmodic medications Tranquilizers Iron supplements Calcium channel blockers

Frequently delaying the need to have a bowel movement

Pregnancy Diabetes Spasm of the anal sphincter, due to painful anal

fissures or hemorrhoids Underactive thyroid Irritable bowel syndrome (periods of constipation

may alternate with episodes of diarrhea)

Neurological diseases such as: Parkinson's disease Multiple sclerosis Stroke Spinal cord injuries Spinal cord tumors

Scleroderma Systemic lupus erythematosus Intestinal disorders, including:

Scarring Tumors Cancer Inflammation

Travel (due to schedule changes, stress, and poor diet)

Risk Factors  A risk factor is something that increases your

chance of getting a disease or condition. Risk factors for constipation include: Advancing age Sedentary lifestyle Prolonged bed rest due to surgery or an accident Diet that is high in fat and sugar but low in fiber

Symptoms  Symptoms include:

Abdominal pain Sensation of abdominal fullness Rectal pain and pressure Difficulty passing stool, despite straining Hard, dry, small stool Black stool "Rabbit pellet" appearance to stool Sensation of retained stool after defecating

Diagnosis  There are over-the-counter medications to treat constipation called

laxatives. However, changes in bowel habits, such as constipation, may indicate a more serious medical condition.

Consult a healthcare provider if client has: Constipation plus:

Abdominal pain Bleeding Black stool Distended abdomen Fever

Consistent and significant change in your bowel habits Constipation that lasts longer than three weeks

Tests to rule out other medical conditions include: Physical exam or blood tests may be performed. Digital rectal exam—examination of the rectum with the doctor's

gloved, lubricated finger inserted into your rectum Abdominal x-ray —a test that uses radiation to take a picture of

structures inside the abdomin Barium enema —injection of fluid into the rectum that makes your

colon light up on an x-ray Flexible sigmoidoscopy —a thin, lighted tube with a camera

inserted into the rectum to examine the rectum and the lower colon

Barium Enema

Treatment  Treatment may include:

Understanding Normal Bowel Movements  Talk to your doctor about what is a normal

frequency of bowel movements for you. The range of normal is quite broad. Some people have several stools a day. Others have one stool every several days.

Making Lifestyle Changes  Eat a healthful, balanced diet that is high in fiber

 (unprocessed bran, whole-wheat grains, fresh fruit, and cereals). Limit your intake of processed and fatty foods.

Exercise regularly. Drink at least eight, 8 oz glasses of water each day.

Taking Laxatives, Stool Softeners, or Glycerin Suppositories 

Regularly using laxatives or enemas can be habit forming. Your bowels can become accustomed to these products and require them in order to produce a stool. Stool softeners, though, are not habit-forming. Ask your doctor about how often and for how long to use these products.

Examples of medications include: Polyethylene glycol 3350 (GlycoLax, MiraLax)—a type of laxative Psyllium —a bulk laxative Docusate —a stool softener Lactulose —a type of laxative Lubiprostone (Amitiza)—a medication that increases fluid in stool Tegaserod —a medication that brings fluids to the colon Colchicine —medication used to treat gout; sometimes used for

constipation Botulism injections—may be used to treat certain types of

constipation

Future Treatments  Prucalopride—not currently approved but

showing promise in clinical trials Cisapride —only available as an

investigational drug; removed from the market

Bowel Retraining  Set aside the same time each day to move your bowels. Typically

this works best after breakfast and coffee. Sit on the toilet for 15-20 minutes. Over time your body will learn to have regular bowel movements at the same time each day.

Biofeedback  Biofeedback works by attaching sensors to the body. A therapist

helps you understand your body’s signals and then you use them to help you move your bowels.

Treating Underlying Medical Conditions  Work with your doctor to treat other conditions that may be

causing your constipation.

Changing Medications  If the client’s mediation causes

constipation, there might be a need to change the medication or simply increase the fluid intake

Prevention  To reduce your chance of getting constipation: Eat a healthy, balanced diet that is high in fiber. Exercise regularly. Drink at least eight, 8 oz glasses of water a day. In an effort to train your bowels, schedule a time daily to

sit on the toilet just after a meal. Don't rush yourself when using the bathroom. If you feel the urge to defecate, listen to your body.

Vitamin B12 Deficiency

Definition  Vitamin B12 deficiency can occur when the body

needs more vitamin B12 than it receives from the diet. Alternatively, the condition may occur when the body is unable to use the vitamin B12 from the diet. A shortage of vitamin B12 can lead to anemia . Anemia is the insufficient delivery of oxygen by red blood cells from the lungs to the cells of the body. The sooner this anemia is treated, the more favorable the outcome.

Red Blood Cells 

Causes  There are many causes of vitamin B12 deficiency. Some are

listed below. Removal of part of the small intestine or stomach Advancing age Long-term use of certain acid-reducing stomach medications:

H2 blockers Proton pump inhibitors

Atrophic gastritis (inflammation of the stomach) due to: Iron deficiency anemia Bacterial infection with Helicobacter pylori Chronic alcohol abuse Autoimmunity

Disorders affecting vitamin absorption: Crohn’s disease Cystic fibrosis Celiac disease Tropical sprue Whipple’s disease Tuberculosis Long-term pancreatitis Pernicious anemia (lack of intrinsic factor) AIDS

Inadequate intake of vitamin B12 Long-term veganism (nonconsumption of animal products) or

vegetarianism Breastfed infants of vegan or vegetarian mothers Poor infant nutrition Inadequate nutrition for a pregnant woman Chronic alcohol abuse

Stillness of the intestinal contents which can be caused by: Abnormal narrowness of intestines Pockets in intestines Connections between loops of the intestine Blind intestinal loops

Intestinal blockage which can be caused by: Diabetes mellitus Scleroderma Amyloidosis

Inflammation of the intestine due to radiation treatment

Inability to use vitamin B12: Lack of a needed enzyme Cancer Malnutrition Nonfunctioning transport protein

Increased need of vitamin B12: Hyperthyroidism Tapeworm affliction Other types of anemia

Over-use of nitrous oxide: Frequent use Extended single use of nitrous oxide (more than six hours)

Metabolic disorders: Methylmalonic aciduria Homocystinuria

Risk Factors  Alcoholism Use of certain drugs:

Biguanides for diabetes Para-aminosalicylic acid

for tuberculosis Calcium-chelating

drugs taken by mouth

Colchicine Neomycin Cimetidine Cholestyramine

Age: over 50 years old Strict vegan or

vegetarian diet

Symptoms  The symptoms of pernicious anemia can

vary from person-to-person. Symptoms may change or worsen over time. If you experience any of these symptoms, do not assume it is due to this anemia. These symptoms may be caused by other health conditions.

Symptoms can include: Sensation of pins and needles in feet

or hands Alternating constipation and diarrhea Stinging sensation on the tongue or

smooth red tongue Substantial weight loss Inability to distinguish the colors

yellow and blue Tiredness Paleness Loss of hunger Altered sense of taste Confusion

Depression Impaired sense of balance, especially

in the dark Ringing in the ears Cracked lips Yellow skin Fever Inability to sense vibrations in feet or

legs Dizziness when changing to standing

position Rapid heart rate

Diagnosis  Tests may include the following:

Complete blood count (CBC)—a count of the number of red and white blood cells in a blood sample

Vitamin B12 level—a test that measures the amount of vitamin B12 in the blood

Methylmalonic acid (MMA) level—a measurement of the amount of methylmalonic acid in the blood; this test determines whether a vitamin B12 deficiency exists.

Homocysteine level—a test that measures the amount of homocysteine in the blood (homocysteine is a building block of protein). The homocysteine level will be elevated if there is a shortage of vitamin B12, folate, or vitamin B-6.

Schilling test—a test in which a harmless amount of radiation is used to assess whether a vitamin B12 deficiency exists (rarely used)

Red blood cell folate level—a measurement of the amount of a B vitamin called folate

Gastrin level—a test that may help determine the cause of a vitamin B12 deficiency

Intrinsic factor assay—a measurement of the amount of a protein called intrinsic factor normally produced in the stomach; this test helps to rule out pernicious anemia as the cause of symptoms.

Bone marrow staining—a test that shows whether an iron deficiency exists

Treatment  Oral Vitamin B12 Supplement 

This treatment consists of high doses of an oral vitamin B12 supplement.

Vitamin B12 Injections  The doctor may advise the patient to receive injections of

vitamin B12 into a muscle. Injections of vitamin B12 may be given 2-4 days per week. When blood tests show improvement, the doctor may give injections on a monthly basis.

Treatment With Antibiotics  This type of medication may be needed in cases where

bacterial overgrowth in the intestines exists. The bacteria compete with the body to absorb the vitamin B12 in the intestines.

Intranasal Vitamin B12  The doctor gives the patient a supplement of vitamin B12 that

is placed in the nose. Oral Iron Therapy 

The physician will recommend this treatment when an iron deficiency exists. In this case, the doctor will tell the patient to take iron supplements before treating with vitamin B12.

Prevention  To help reduce your chances of developing a

deficiency of vitamin B12, take the following steps: Avoid long-term over-consumption of alcohol. As directed by your doctor, take a daily

supplement containing vitamin B12. As directed by your doctor, give vitamin B12 to your

breastfed baby if you are a vegan or vegetarian.

Avoid overuse of nitrous oxide. Seek diagnosis and treatment of any

suspected tapeworm infestation. Have your doctor check you for iron

deficiency. Undergo testing if your doctor suspects you

are infected with the bacterium Helicobacter pylori .

Have you’re a health care provider monitor your health closely if you are taking the following drugs: Biguanides Aminosalicylic acid Calcium-chelating drugs taken by mouth Colchicine Neomycin Cimetidine Cholestyramine

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Endocrine System Disorders of the Older Adults

Hypothyroidism 

Definition  Hypothyroidism happens when the thyroid

gland does not produce enough thyroid hormone. The thyroid gland is a butterfly-shaped gland in the front of the neck. It produces hormones that control metabolism. The most common form is Hashimoto's thyroiditis.

Thyroid Gland 

Causes  Hashimoto's thyroiditis occurs when the immune system produces antibodies that

attack cells of the thyroid gland. This causes chronic thyroid swelling and loss of function. Other causes include:

Idiopathic thyroid atrophy—destruction of thyroid tissue for unknown reasons Iodine deficiency—when a thyroid gland needs iodine to produce thyroid hormone

(rare in the US) Subacute thyroiditis—following a viral upper respiratory tract infection Medical treatments— radiation to the head and neck or surgical removal of the

thyroid gland (called subtotal thyroidectomy ) Medicines (eg, lithium , iodine, alpha-interferons, thiourea, amiodarone ,

interleukins) Certain diseases (eg, cancer or infection) Pituitary adenoma —benign tumor of the pituitary gland

Risk Factors  Risk factors include:

Age: risk increases with age, especially over 65 years old Sex: more common in females Genetics: multiglandular autoimmune syndrome Ethnicity: Caucasian, Hispanic History of family members with hypothyroidism History of other autoimmune diseases:

Pernicious anemia Type 1 diabetes Underactive adrenal or parathyroid glands Rheumatoid arthritis Lupus

Symptoms  Symptoms include:

Fatigue Weakness Coarse, brittle hair; hair loss Facial puffiness Dry skin Swollen hands or feet Cold intolerance Weight gain

Constipation Achy feeling all over Depression and irritability Memory loss Difficulty with concentration Blurred vision Menstrual abnormalities or 

infertility

Symptoms of severe or prolonged cases include: Stupor or coma Slow heart rate Depressed breathing Hypothermia (low body temperature) Hoarseness

Diagnosis  The doctor will ask about your symptoms and

medical and family history, and perform a physical exam. To confirm the diagnosis, blood tests will be done, which include:

Thyroid stimulating hormone (TSH) Free T4 and total T3 Antibodies that attack the thyroid gland

Treatment  In the early stages of Hashimoto's thyroiditis,

there is no specific treatment. Treatment includes:

Medicine to replace the thyroid hormones (eg, levothyroxine , triiodothyronine)

High-fiber diet to reduce constipation Low-fat , low-calorie diet if you are overweight or 

obese

Prevention  To help reduce your chance of getting

hypothyroidism, take the following steps: Get a screening test every five years if you are 50

years old or older. Get regular screenings if you:

Have Type 1 diabetes Have infertility (females) Take certain medicines

Type 2 Diabetes

Definition  Glucose comes from the breakdown of food. It is the body's

energy source. It can be absorbed from the blood into the cells with the help of a hormone called insulin . Without insulin, glucose will build up in the blood and cause hyperglycemia. At the same time, your body's cells are starved for glucose (energy).

A lack of insulin or resistance to insulin causes diabetes. In type 2 diabetes, the body is resistant to high levels of insulin. There is plenty of insulin in the body, but the cells are unable to use it.

High blood sugar levels over a long period of time can damage vital organs. This can include the kidneys, eyes, and nerves.

The Pancreas 

Causes  Two conditions contribute to hyperglycemia

in type 2 diabetes: Insulin resistance related to excess body fat Body's failure to make an adequate amount of

insulin

Risk Factors  Factors that increase your chance for

type 2 diabetes include: Having a family history of type 2

diabetes Being obese or overweight (especially

excess weight in the upper body and abdomen)

Eating a lot of meat, especially processed meat (eg, processed luncheon meats, hot dogs, sausages)

Having cholesterol problems (low HDL "good" cholesterol and high triglycerides )

Having high blood pressure Having a history of cardiovascular

disease Having a history of gestational diabetes

 or having a baby that weighs over nine pounds

Having an endocrine disorder ( Cushing’s syndrome , hyperthyroidism , acromegaly ,polycystic ovary syndrome , pheochromocytoma, glucagonoma)

Risk Factors  Having a condition associated

with insulin resistance (eg, acanthosis nigricans )

Having previous blood test results that show impaired glucose tolerance and impaired fasting glucose

Taking certain medicines (eg, pentamidine , nicotinic acid, glucocorticoids, thiazide)

Having a sedentary lifestyle Having sleep difficulties

Having a low birth weight Gender: more common in older

women than men Race: African American,

Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander

Age: 45 years or older and younger people who are obese and belong to at risk ethnic groups

Symptoms  Symptoms due to high blood sugar

or diabetic complications may include: Increased urination Extreme thirst Hunger Fatigue Blurry vision Irritability Frequent or recurring infections

Poor wound healing Angina Painful leg cramps when walking Numbness or tingling in the hands or

feet In women: frequent 

vaginal yeast infections and urinary tract infections

Problems with gums Itching Impotence

Diagnosis  Diagnosis is based on the results of blood testing. These guidelines are from

the American Diabetes Association (ADA): Symptoms of diabetes and a random blood test revealing a blood sugar level

greater than or equal to 200 mg/dL [11.1 mmol/L] Blood sugar tests after you have not eaten for eight or more hours (called

fasting blood sugar ) revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days

Glucose tolerance test measuring blood sugar two hours after you consume glucose with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)

HbA1c level of 6.5% or higher, indicating poor blood sugar control over the past 2-4 months

mg/dL=milligrams per deciliter of blood; mmol/L=millimole per liter of blood

Treatment  Treatment aims to:

Maintain blood sugar at levels as close to normal as possible

Preventing or delaying complications (regular medical care is important for this)

Control other conditions that you may have, like high blood pressure and high cholesterol

Diet  Follow a balanced meal plan. Eat consistent and moderate amounts of

food at regular times. Nuts and peanut butter are a good choice for a snack. In women with

diabetes, these snacks may help reduce the risk of cardiovascular disease. Do not skip meals. Eat plenty of vegetables and fiber . Eat limited amounts of fat . Eat moderate amounts of protein and low-fat dairy products . Carefully limit foods containing high concentrated sugar . Keep a record of your food intake. This will help a dietitian or doctor

advise you.

Weight Loss  If you are overweight, talk to your doctor

about a reasonable weight goal. You and your doctor can develop a safe diet program for you. Weight loss will help your body respond better to insulin.

Group education may help people recently diagnosed with their goals in weight loss.

Exercise  Physical activity:

Can make the body become more sensitive to insulin Will help you reach and maintain a healthy weight Can lower the levels of fat in your blood Has been found to improve blood sugar control— Aerobic fitness, and resistance training

can help to improve HbA1c levels. Researchers have also found that long-term strength and endurance training may improve HbAIc, even in the absence of weight loss.

Talk to your doctor about any restrictions. Work with your doctor to make an activity plan. Even a brief counseling session may help to increase your activity levels.

Diabetes is a risk factor for heart disease. Exercising can help to reduce risk for heart disease.

Oral Medication  Medicines taken by mouth may be used to lower blood sugar:

Metformin : a class of drug that reduces the body's production of glucose. It also makes the body more sensitive to insulin. This combination will help keep blood sugar levels within the normal limits.

Drugs that prompt the cells in the pancreas to make more insulin (eg, sulfonylureas [glyburide , tolazamide ], dipeptidyl peptidase-4 inhibitors [ saxagliptin , sitagliptin ], repaglinide[Prandin])

The FDA has warned that sitagliptin may increase the risk of acute pancreatitis. Insulin sensitizers—a class of drugs that help the body better use insulin

(eg, pioglitazone ) Starch blockers—a class of drugs (eg, acarbose , miglitol ) that lessen

glucose absorption into the bloodstream

Injectable medicine, such as: Incretin-mimetics (eg, exenatide ) stimulate the

pancreas to produce insulin and suppress appetite often leading to weight loss (twice daily injections).

Amylin analogues (eg, pramlintide ) replace a protein that is normally produced by the pancreas and is low in people with type 2 diabetes (injection before each meal).

Talk to your doctor about your drug program.

Insulin  In some cases the body does not make

enough insulin. Insulin injections may be needed.

This is needed when blood sugar levels are not kept low enough with lifestyle change and medicine.

Blood Sugar Testing  Checking blood sugar levels during the day can

help you stay on track. It will also helps your doctor determine if your treatment is working. Testing is easy with a monitor. Keeping track of blood sugar levels is especially important if you take insulin. Frequency of testing is determined by how well your blood sugar control is doing.

The HbA1c may also be done at your doctor's office. Doctors advise that most keep their HbA1c levels below 7% (ADA recommendation). This level has been shown to lead to fewer diabetic complications.

Regular blood sugar testing may not be needed in patients with type 2 diabetes. It may not be needed for those whose condition is under reasonably good control without insulin. Talk with your doctor before stopping blood sugar monitoring.

Alternative Therapies  One study focused on people with a specific

type 2 diabetes. When given vitamin E, they showed a decrease in the rates of heart problems.

Prevention  Lifestyle changes seem to be most effective. To reduce your

chances of developing type 2 diabetes: Participate in regular physical activity. Maintain a healthy weight. Drink alcohol in moderation (two drinks per day for a man, and one

drink per day for a woman) Eat a well-balanced diet:

Get enough fiber Avoid fatty foods Limit sugar intake Eat more green, leafy vegetables

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