Running head: PRACTICUM JOURNAL ENTRY ASSESSING A GERIATRIC PATIENT 1

Practicum Journal Entry Assessing a Geriatric Patient

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Practicum Journal Entry Assessing a Geriatric Patient

The psychology of a human being is complicated with a continually changing state with age-

related changes which occur at the functional, molecular and structural levels (Brown, 2015). The

ageing process of multifactorial and sophisticated with a variety of hypothesis which is assumed

to be either error or programmed theory (Brown, 2015). According to Brown, 2015, the error theory

states describes the secondary accumulation of free radicals to reactive oxygen species which are

generated during the mitochondrial production of energy, thus causing damage to the DNA,

lipids and the proteins (Brown, 2015). The programmed theory focuses on the delineation of

biological alterations in natural defence and homeostatic state, which is meant to occur over time

continually. However, despite what the theories state, the ageing process is considered to be

normal and natural. Ageing is described as the normal and progressive decline in the ability and

functioning in relation to response to inflammation and catecholamine or surgery and infections (

extrinsic) stimuli (Brown, 2015). Age has a strong correlation with the risks of mortality and

morbidity. Age is also a risk factor for a variety of health conditions such as cardiac diseases and

mental disorders and hospitalizations, adverse reactions to drugs and injuries. However, it is

sometimes difficult to differentiate between age-related disorders and disorders that are not age-

related. Functional assessments are crucial tools used by healthcare providers to distinguish

normal and abnormal disorders in elderly patients. Therefore, this paper discusses the

implications of age-related changes in geriatric patients. The article also describes how to

differentiate between abnormal disorders not related to ageing and unusual diseases related to

ageing. Finally, the paper explains how functional assessments may be useful in differentiating

between normal and abnormal disorders in elderly patients.

Implications of age-related changes in geriatric patients

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Considering the 92-year-old patient who reported to the hospital and diagnosed with a variety of

disorders such as osteoporosis, restless legs syndrome, hypertension and mild chronic anaemia, it

is evident that ageing has an enormous number of adverse effects on geriatric patients. The

patient also reported that he had previously lost his way while driving to a familiar location,

indicating that he also experiences memory loss. According to asjbce, the brain of an ageing

person is accompanied by changing the functioning, metabolism and structure. The brain volume

decreases at the rate of about 6% per decade after the age of forty years. The decline rate

increases at the age of seventy years and above. The neurological changes are said to start earlier

in men than in women. Therefore, the changes may be accompanied by a variety of neurological

disorders, including memory loss. For instance, the man who reported to the hospital is aged 92

years; thus, the rate of changes in his brain is high since he is over seventy years, which is why

he reported that he lost his direction while driving to a familiar place.

Moreover, geriatric patients may have high blood pressures due to the changes in the

cardiovascular system. Thus, the ageing population tend to have more cases of stroke, ejection

fractions and other cardiovascular diseases compared to the young people. Cardiovascular

conditions result from the changes in the connective tissues which start to stiffen within the

myocardium, veins and arteries, making them less compliant. The changes begin in the fourth

life's decade. Moreover, sometimes the inefficiency of the connective tissues may limit the

amount of blood flowing to the brain and the body as a whole. As a result, the person may end up

experiencing cases of anaemia. For instance, the 92-year-old patient had been diagnosed with

hypertension and mild chronic anaemia. His age is over 40 years, where the connective tissues

start to be less compliant.

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Other implications of age-related changes in the geriatric population include a reduction in their

brain processing speed, reduction in both selective and divided attention, and executive

functioning. The ageing process affects the functioning of every organ in the body. For instance,

production of hormones such as thyroxin is reduced; the muscles become weak, leading to the

cases of such conditions as osteoporosis and arthritis.

Differentiation between normal disorders due to ageing and abnormal disorders which are

not related to age

Ageing is a normal and gradual process that is associated with a decrease in cognitive abilities

such as executive functioning, processing speed and visuospatial abilities. The changes are

minor, and they should not result in the total dysfunctioning and impairment of the body organs.

For instance, the weight and the volume of the brain start to decline at the age of 40 years at a

rate of about 6% per decade. The rate of decline increases again after the age of 70 years.

Therefore, normal disorders due to age and abnormal disorders not related to age can be

differentiated through the identification of the patient's age and the speed at which he is ageing.

Moreover, healthcare givers, and use functional assessments to distinguish between age-related

cognitive disorders and cognitive disorders that are not rated to ageing.

The distinction between normal and abnormal ageing through functional assessment

Functional assessment may help distinguish between normal and abnormal cognitive disorders

related to age. The functional evaluation uses a variety of tools to assess the functioning of

geriatric patients. The ageing process of a person should be gradual. For instance, if a forty-year-

old patient is unable to do activities of daily living such as bathing, eating and dressing by
PRACTICUM JOURNAL ENTRY ASSESSING A GERIATRIC PATIENT 5

herself, her cognitive behaviour can be said to be abnormal and not related to age. Some of the

tools used for functional assessment include the Katz ADL scale which examines the functioning

ability of geriatric patients based on IADL ( instrumental activities of daily living) and ADL

( Activities of daily life.)

The functional assessment also evaluates the functioning ability through the physical health of

the geriatric patient though such criteria as the medical history of the patient, current illness,

social and family history, a review of the systems and demographic data. The physical

examination and history are normally specific to geriatric patients. Factors such as hearing,

nutrition, vision, urinary continence, fall prevention and osteoporosis are also included in the

assessment. The physician can differentiate the patient condition to be normal or abnormal based

on the age of the patient from the data collected from the evaluation. For instance, the cognitive

condition of the patient may be found to be genetic from the information obtained from the

medical, social and family history of the patient. Screening is also another tool used in the

functional assessment and can help determine whether the cognitive disorder with the patient is

normal or abnormal depending on his age. For instance, the physician may use a mini-Cognitive

Assessment Instrument to tell if the patient cognitive disorder is age-related or dementia.

However, if cognitive disorders are detected earlier, they may be treated and prevent future

occurrence at an older age.

In conclusion, ageing is a continuous and gradual process that is considered normal and natural.

However, some changes occur in the body as the ageing process takes place. The changes have a

variety of implication to the ageing population, such as memory loss to the decline in the volume

and the weight of the brain, reduced processing speed and executive functioning. The changes in

the cardiovascular system may result in such conditions as hypertension, anaemia and stroke and
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other cardiovascular diseases. Also, the muscles become weak, and the geriatric patient may

have a deficiency in some crucial nutrients such as Vitam D, Vitam C and Vitam B12, which are

essential for healthy bones. Thus, geriatric patients may develop such conditions as osteoporosis

and increased immobility rates. The ageing speed differs from one stage to another. For instance,

connective tissues inefficiency begin at the age of 40 years. Also, the brain functioning

deteriorates at a rate of approximately 6% per decade after the age of 40 years and the decline

increases at the age of 75 years. Therefore, it is possible to distinguish between normal cognitive

disorders related to age and abnormal disorders that are not age-related through the age of the

geriatric patient. Also, functional assessment tools such as Kartz ADL scale and mini-cognitive

assessment instrument may be used to differentiate between normal and abnormal cognitive

disorders. Functional assessments through the medical history, family and social history of the

patient can be used to identify age-related diseases and abnormalities that are not age-related.
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References

Brown, C. (2015). Geriatric Anesthesia, An Issue of Anesthesiology Clinics (Vol. 33, No. 3). Elsevier

Health Sciences.  doi: 10.1016/j.anclin.2015.05.003

Elsawy, B., & Higgins, K. E. (2011). The geriatric assessment. American family physician, 83(1), 48-56.

Retrieved from https://www.aafp.org/afp/2011/0101/p48.html

Franceschi, C., Garagnani, P., Morsiani, C., Conte, M., Santoro, A., Grignolio, A., ... & Salvioli, S. (2018).

The continuum of ageing and age-related diseases: common mechanisms but different rates. Frontiers in

Medicine, 5, 61. doi: 10.3389/fmed.2018.00061

Harada, C. N., Love, M. C. N., & Triebel, K. L. (2013). Normal cognitive ageing. Clinics in geriatric

Medicine, 29(4), 737-752. doi: 10.1016/j.cger.2013.07.002

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2013). Geriatrics at

your fingertips. Retrieved from https://ir.uiowa.edu/nursing_pubs/2077/

Rosen, S., & Reuben, D. ( 2011). Geriatric Assessment Tools. The Mount Sinai Journal of

Medicine. New York 78 (4) 489-497