Acute illnesses are short-term physical problems that occur because of injury from infectious agents or accidents. Acute illnesses are generally preventable, treatable, and nonfatal. Elders are no more susceptible than younger persons in acquiring an acute illness, but once acquired may have more difficulty fighting off an infection or healing a wound. Therefore, in the elder population acute illness has an added risk of becoming chronic or fatal. The content of this unit includes the most common acute illnesses experienced by elders, factors that lead to increased risk for acute illness, and the impact of age and the environment on the recovery of the adult. Select from the following set of readings for this module.
The most common acute illness is from infection, primary and dormant (latent) types. The primary types of infection are respiratory in nature (colds, flu, and pneumonia). Some infections arise from bacteria and viruses laying dormant for years after exposure. Shingles (Herpes Zoster) is caused by the same virus that caused chicken pox at an earlier age. Tuberculosis is another condition that reactivates years after exposure into a full-blown infection. It is generally accepted that these infections only activate in those persons who are frail and have compromised immune systems. Other acute illnesses common in elders relate to infection, irritation, or inflammation in areas of the gastrointestinal and urinary tract. Complaints such as indigestion, constipation, painful urination, or heartburn are common. They can be minor problems related to some irritation or inflammation caused by foods, allergies, stress, or insufficient intake of fluids. They can also be signs of underlying illnesses, and therefore need careful assessment. Pressure sores (decubitus ulcers) are injury to the skin and surrounding soft tissue. This destruction occurs after the blood supply to the area has been cut off by pressure for a period of time. The lack of blood deprives the cells of needed oxygen and other nutrients necessary for cell life. These pressure sores usually occur with immobility, lying or sitting in one position too long. At risk are those elders with an already compromised circulation, those immobile from injury, disease, or in the process of dying. Pressure sores are preventable by reminding or assisting the person in changing positions frequently. The timing depends upon the situation, but a good rule of thumb is to remember that anything over two hours has already begun the process of starving the cells of needed oxygen. Another prevention technique is the application of pressure release devices such as special mattresses, cushions, and padded joint protectors. Environmental exposure also can cause acute illness. Hyperthermia is a highly elevated body temperature resulting from a high fever or overexposure to high environmental temperature. Sweating is the natural process the body uses to cool itself, and as we age our ability to sweat decreases. Hypothermia is having a lowered body temperature as a result of overexposure to a cold environmental temperature without sufficient protection. Both conditions can be prevented, or be fatal without appropriate medical care. Incontinence Urinary incontinence is not an inevitable part of the aging process, rather is a result of an underlying physical problem and in most cases treatable. Therefore urinary incontinence is covered in this unit about acute illness rather than in the unit on chronic illness. Conservative estimates of the incidence of urinary incontinence occurring in adults is at least 11 million adults living in the community and approximately 50% of all nursing home residents with a combined medical cost for treatment at about 10.3 billion dollars (Agency for Health Care Policy and Research, 1992). An indirect cost of urinary incontinence relates to the psychosocial impact resulting in depression, social isolation, embarrassment, and a negative impact on health from the abandonment of exercise activities (Nygard, DeLancey, Arnsdorf & Murphy, 1990). In most cases for women, the problem is a result of weakened pelvic floor muscles. In men, an enlarged prostate is usually the underlying physical problem. The extent of urinary incontinence ranges from leaking a few drops of urine to the inability to control the flow of urine. The four types of urinary incontinence are:
Treatments for urinary incontinence are usually successful. A good assessment by a trained professional is required. Treatments consist of medications, surgery, and behavioral therapy. Behavioral treatments range from developing a pattern of increased frequency of bathroom habits to techniques geared toward strengthening the pelvic floor muscles. One such technique is Kegel exercises. This technique involves the individual starting and stopping their flow of urine multiple times. Another treatment for urinary incontinence is biofeedback therapy. Similar to Kegel exercises, biofeedback therapy intervention includes teaching the person to strengthen the pelvic floor muscles. For the latter treatment a sensor is used to measure muscle tension; it provides feedback information to the person to ensure they are doing the exercise correctly. SECTION 2: ACCIDENTS/FALLSThe most common accidents among elders are from falls, automobiles, burns and choking. Accidents can result from external factors such as loss of balance from tripping on a curled carpet mat or from the side effects of a medicine. Accidents can also be caused from intrinsic factors such as loss of balance from a disease that impairs circulation to the brain or heart, or disease that causes gait disturbances. Factors that raise the risk of accidents are behaviors that lead to being accident prone. These behaviors include drinking alcohol, mixing alcohol and drugs, and even denying or becoming angry with physical limitations to the point of refusing to use assistive devices. SECTION 3: ADDICTIONS & HEALTH
Older adults are more sensitive to alcohol and drugs, experiencing more of the effects with smaller amounts. The physical changes that occur with aging are responsible for the increased sensitivity. For example: less water volume available for dilution; decreased kidney function involved in preserving and excreting fluids; slowed liver function needed for metabolism, probable increased ability to cross the blood-brain barrier into the brain; increased risk of hypotension due to cardiovascular changes; and reduced stomach secretions needed to protect stomach lining from toxic effects. Misuse and abuse of drugs is covered in Unit 6 on medications. Alcoholism is a chronic illness that has a major role in contributing to or causing acute illness because of the effect of memory and balance. Falls, malnutrition, choking on food, incontinence, depression, dementia, and infections from depressed immune system are some of the examples of acute problems that arise secondary to alcoholism. There are three types of alcoholics in the older population. Early-onset alcoholics have abused alcohol most of their lives and are encountered early on in the medical system because of the long-term physical effects. Late-onset alcoholics begin drinking after age forty, usually because of boredom, loneliness, or a response to loss. Intermittent alcoholics use alcohol as an anti-anxiety agent for its depressant effects during stressful events. Treatment programs have neglected the older adult population probably because of a myth that elders are considered a poor risk for treatment. Research has shown that elders do as well as younger adults in treatment, have longer treatment plans because of more complex medical condition, and the potential for success is even greater when treated in a peer age group (Closser & Bow, 1993). Treatment for elders is the same as for younger alcoholics, except the use of Antabuse is not recommended (Lamy, 1988). SECTION 4: STRESS & IMMUNE FUNCTIONStress is a normal part of life experienced by all individuals. Various physical and emotional stressors confront individuals daily. Examples of stressors include weather changes, injury, pollution, time pressures, difficult tasks, and losses. Everyone experiences stress differently depending upon our perception of the level of threat to our physical or emotional well-being the stressor posses. It is the meaning behind the event that makes it stressful emotionally. Physically, we experience more response to the stressor if our immune system is impaired or has been stressed too long. Prolonged levels of stress can lead to increased risk for acute illness. The physical response to a stressor is mediated by the sympathetic nervous system, the " fight or flight" response. Once this system is stimulated a cascade of events occurs. The pituitary gland causes the release of adrenocorticotropic hormone (ACTH), thus stimulating the release of adrenaline. The resulting changes to the body include cold hands and feet as blood moves into the larger muscles, more glucose produced for needed energy, pupils dilate (enlarge) to allow more light, hearing becomes more acute, blood pressure, heart rate, anxiety and fear increases, and ability to concentrate decreases. The clarity needed for decision making is diminished during this response placing elders at risk for injury. Hans Selye (1976) described this reaction in the General Adaptation Syndrome. The important aspect of this syndrome is that life is based on a series of stress response and recovery episodes. When multiple stressors occur over a short time period so recovery does not occur, then the immune system becomes overloaded and the body becomes more susceptible to illness and injury. A lowered immune response from prolonged stress reaction has been associated with illness such as cancer, arthritis, respiratory infections, and cardiovascular disease (Pelletier, 1977; Cousins, 1989). SECTION 5: STRESS MANAGEMENT & HEALTHStress cannot be avoided. Rather, it is something to be managed. Managing stress starts with responding in a healthy manner. Exercise, good nutrition, and proper rest provide us with the ability to confront stress. Managing our lifestyle involves putting into perspective the issues that tend to exaggerate our stress response. For example, realizing that ten more minutes making you late or putting off a chore to next day really won't matter in the big scheme of things. One way of learning to relax is to get absorbed in an activity that provides respite from the stressors of life. Examples of such activities include planning quiet time for meditation, music or reading, sporting activities, travel, and handcrafts or artwork. It is "... important to remember that the progression toward disease can be interrupted, through early intervention, through the use of stress-reduction techniques, and through educating people about life styles more conducive to health maintenance" (Pelletier, 1977, p. 157). Stress reduction techniques include:
Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. (1992). Urinary Incontinence Guideline Panel. Urinary Incontinence in Adults: Clinical Practice Guidelines. AHCPR Pub. no. 92-0038. Rockville, MD:Author. Closser, M. & Blow, F. (1993). Recent Advances in Addictive Disorders: Special Populations: Women, Ethnic Minorities, and the Elderly. Psychiatric Clinics of North America, 16(1), 199-209. Cousins, N. (1989). Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York: Penguin books. Lamy, P. (1988). Actions of Alcohol and Drugs in Older People. Generations, 12(4), 9-13. Nygard, I., DeLancey, J., Arnsdorf, L. & Murphy, E. (1990). Exercise and Incontinence. Obstetrics and Gynecology, 75, 848-851. Pelletier, K. (1977). Mind as Healer, Mind as Slayer. New York: Dell Pub. Selye, H. (1976). The Stress Of Life. New York: McGraw-Hill. Bortz, W.II Disuse and Aging. JAMA vol 248, No 10, Sept 10, 1982.pg 1203- 1208.Fail to snooze, immune cells lose. Science News. Vol 147 Jan 7, 1995. R&R for your arteries breaking stress's grip. Longevity Mar 1992. Weil, A. Natural Remedies Relieve Arthritis. Natural Health, Sept/Oct 1993. Williams, G III. The power of positive feeling, the case for healthy doses of emotion. Longevity. Nov. 1992 |