Benchmark Common Syndromes Geriatrics
Benchmark Common Syndromes Geriatrics
A geriatric syndrome is a term used to describe those clinical conditions affecting old people, which cannot be classified in a particular disease category. Sleep disorders are very prevalent among the elderly population. When people grow older, their patterns and habits of sleep change. As a result, they may suffer from difficulties in falling asleep, poor quality sleep, waking up frequently in the night, and sleeping for few hours. These symptoms have an adverse impact on the quality of life and predispose most elderly people to disabilities. The main complaint does not signify a particular disease demonstrated in the change of the health state of the individual. Therefore, geriatricians are very careful while dealing with patients suffering from sleep disorders or insomnia, where a thorough clinical checkup is very necessary to exclude other pathological conditions with the same presentation. The paper will expound more on this specific geriatric syndrome, its presentation, differential diagnosis, and plan of care.
Sleep disorders are underreported and underdiagnosed being the primary basis of concern in the elderly population. Several factors play a significant role in the development of such problems. They include circadian rhythm changes, spouse death, health problems, and retirement (Wolkove, Elkholy, Baltzan, & Palayew, 2007). Variations in sleep patterns may be part of the usual process of aging. However, most of these changes may be linked to pathological processes (Wolkove et al., 2007). These disorders also affect the quality of life due to a prolonged daytime sleep, as well as cognitive, psychological, and physical challenges. Apart from all these problems, they also increase the mortality rate among the elderly (Bloom et al., 2009). Besides, the number of drugs utilized seems to increase because older age contributes to a rise in mortality, morbidity, and medications side effects like sleep problems, impairment in cognition, and falls (Bloom et al., 2009). As a result, sleep disorders among the elderly are a syndrome that needs the collaboration of all stakeholders for its active management.
Typical Presentation of Sleep Disorders in A Patient
The patient can present the symptoms of the lack of enough sleep, including not feeling rested, failure to sleep, taking prolonged time before one goes to sleep in the night, lack of concentration, and frequent awakening in between sleep (Bloom et al., 2009). Such a patient may also present with a difficulty in sleeping after awakening, excessive sleepiness during the day, suffering from sleep apnea, snoring, and waking up confused. Typical presentation also includes headaches in the morning and gasping for breath when older adults wake up (Vaz Fragoso & Gill, 2007). A geriatric person suffering from sleep disorders will present these typical symptoms.
Differential Diagnoses for Sleep Disorders
Sleep disorders can be precipitated by many health conditions, and therefore it is the work of the medical professional to exclude all other causes before concluding that the syndrome is age-related. Differential diagnoses for such health problems include schizophrenia, restless leg syndrome, post-traumatic stress disorder, periodic limb movement disorder, Parkinson-plus syndromes, gastroesophageal reflux disease, and depression (Wolkove et al., 2007). They also encompass delirium, chronic obstructive pulmonary disease (COPD), childhood sleep apnea, bipolar affective disorder, and anxiety disorder (Vaz Fragoso & Gill, 2007). After analyzing a comprehensive history of the patient, the physician may find it useful to refer the person to a sleep disorder center for further examination of sleep apnea.
A Care Plan for a Geriatric Patient with Sleep Disorders
A care plan for a geriatric patient suffering from sleep disorders should consider social-economic and psychosocial implications and wellness care (Bloom et al., 2009). The primary goal of treatment will be to manage the symptoms and normalize sleeping patterns of a person. Several interventions can be used to achieve this goal. One of them includes following healthy lifestyles with such suggestions as avoiding taking naps, using the bed only for sleep or sex, going to sleep and waking up at the same time on a daily basis, and exercising regularly early in the morning. These tips also encompass avoiding stimulants like caffeine in the afternoon and large meals shortly before sleeping, as well as sleeping in a quiet room (Bloom et al., 2009). Following these recommendations can help to reduce the symptoms of insomnia.
Another intervention includes the use of non-pharmacological therapies, which can be administered alone or either in combination with other pharmacological treatment methods. They include behavioral techniques, like progressive muscle relaxation, stimulus control, cognitive-behavioral therapy, biofeedback and sleep restrictions (Vaz Fragoso & Gill, 2007). These interventions have proven to be efficacious in controlling insomnia and have positive psychosocial implications in geriatric patients, including alleviating their suffering and distress. They also encompass helping people to cope with their situations, resume their normal lives, and to become integrated in the community social life.
Other interventions include the use of pharmacological agents to monitor the symptoms of insomnia. These drugs include benzodiazepines and benzodiazepines-like ones (Ancoli-Israel & Ayalon, 2006). Their brand names are Zaleplon, Temazepam, Triazolam, Lorazepam, and Zolpidem. These medicines should be used carefully because they cause dependence if used for long (Ancoli-Israel & Ayalon, 2006). Other class of drugs includes antidepressants and melatonin receptor stimulants like ramelteon. They reduce the symptoms of insomnia among elderly patients (Wolkove et al., 2007). These interventions promote the wellness of the elderly population. The interdisciplinary collaboration to support this care plan includes nurses, doctors, pharmaceutical technicians, physiotherapists, laboratory technicians, geriatricians, as well as the patient and his or her relatives.
Insomnia or sleep disorders are a serious issue among elderly people because of their great prevalence. They are linked with increased morbidity and mortality and raise the probability of being admitted to a hospital. It is significant for a health professional to understand the typical presentation of insomnia among the elderly, such as the lack of concentration and the failure to sleep, for making an adequate diagnosis. The doctor should be conversant with differential diagnoses of insomnia caused by the increased age for the proper management of the condition. The treatment of this syndrome involves both non-pharmacological and pharmacological interventions. Thus, sleep disorders among the elderly can be managed effectively if well diagnosed.
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