Infectious diseases
With age the defence system becomes weaker. Common infections are chest infection (pneumonia), urine infection, flu, and skin infection.
- Signs can be quiet: tiredness, confusion, not eating, a fall. High fever may be missing.
- Nursing: check temperature, pulse, breathing and alertness; keep fluids going; report early; give antibiotics on time as ordered.
- Prevention: vaccines (flu, pneumonia), hand washing, mouth care, and moving about.
Fractures
Older bones lose strength (osteoporosis), so a simple fall can cause a fracture. The hip, wrist and spine are common places.
- Signs: pain after a fall, cannot stand or walk, swelling, an odd shape or short leg.
- First help: do not move the part. Call for help. Keep the person warm and calm.
- After treatment: help the person to move early, give pain relief, watch the skin, teach safe walking and exercise.
- Prevention: dry floor, good light, no loose mats, a stick or walker, sensible shoes, and food rich in calcium and vitamin D with sunlight.
Parkinsonism
In Parkinsonism the brain makes too little of a chemical called dopamine. Movement becomes difficult.
- Signs: shaking at rest (tremor), stiff muscles, slow movement, small shuffling steps, a still face, soft voice.
- Nursing: give medicines exactly on time; allow extra time for dressing, eating and walking; use clear paths, grab bars and a walker; remind the person to take big steps; protect from falls; watch swallowing and weight.
- Be patient and let the person do as much as possible. The mind is usually clear.
Dementia
Dementia is a slow loss of memory, thinking and daily skills over months and years. It is not normal ageing.
- Signs: forgetting recent things, getting lost, trouble with words, mood change.
- Nursing: keep a fixed routine, speak calmly and simply, face the person, do not argue or quiz, keep the home safe (lock doors, remove hazards), use clocks and pictures, give meals and drinks, and support the family.
Depression
Depression is more than sadness. The person feels low for weeks, loses interest, sleeps badly, eats less and may feel worthless.
- Often missed in older people, because it looks like tiredness or aches.
- Nursing: listen without hurry, encourage company and gentle activity, keep a routine, tell the doctor, and give medicines as ordered.
- Safety: if the person speaks of death or self-harm, never ignore it. Stay with the person and tell the doctor at once.
Delirium
Delirium is a sudden confusion that comes over hours or days and goes up and down. The person may be sleepy or restless, and see things that are not there.
- Causes: infection, thirst, pain, new medicines, low sugar, constipation, a strange place.
- Nursing: report at once; find and treat the cause; keep a calm, well-lit room; clock and calendar; glasses and hearing aid; family face; day-night routine; keep safe.
- Delirium is an emergency but can often be reversed.
Dementia or delirium? Dementia = slow, over years. Delirium = sudden, over hours or days, and it fluctuates.
Try it
Try it: In the 3D, jump to step 5 and watch the two graphs. Say aloud which one is a slow slide and which one is a sudden dip that comes back. Then ask: "Which one needs a doctor today?"
Key formulas and definitions
- Infection in the old = quiet signs (confusion, not eating)
- Fracture = fall + weak bone: prevent falls, move early
- Parkinsonism = tremor + stiffness + slow small steps
- Dementia = slow (months to years); Delirium = sudden and fluctuating
- Depression = low mood for weeks: listen, tell the doctor
Worked examples
1. A 80-year-old man is calm in the morning but sudden confusion starts by evening, and he has a urine infection. Dementia or delirium?
Delirium. It came suddenly and is linked to an infection. Report it, treat the cause, keep him safe and calm.
2. Name three ways to prevent falls at home.
Keep the floor dry, light the way at night, remove loose mats, use a stick or walker, wear non-slip shoes.
3. A woman with Parkinsonism takes her tablet late and is very stiff. What does this teach the nurse?
Medicines must be given exactly on time, because a delay brings back stiffness and tremor.
Common mistakes
- Calling every change "old age". Sudden change always has a cause.
- Mixing up dementia and delirium. One is slow, the other is sudden.
- Arguing with a person who has dementia. It only raises fear. Use calm, simple words.
- Ignoring talk of death in a depressed person. Always report it.