医学英语-老年痴呆

Unit2HumanGrowthandDevelopmentHumangrowthanddevelopmentisaprocessthatbeginsatbirthanddoesn’tenduntildeath.Duringallstagesofgrowthanddevelopment,individualshavedifferentneedsthatmustbemet.Andasagingoccurs,certainphysical,psychological,andevensocialchangesalsooccurinallindividuals.Someindividualscanlearntoadapttoandcopewiththechanges,butothersexperiencesextremefrustrationandmentaldistress.Itisimportantforthehealthcareworkerstobeawareofthevariouslifestagesinordertoprovidequalityhealthcare.TextAConfusionandDisorientationintheElderlyAlthoughmostelderlyindividualsremainmentallyalertuntildeath,someexperienceofconfusionanddisorientation.Signsofconfusionordisorientationincludetalkingincoherently,notknowingtheirownnames,notrecognizingothers,wanderingaimlessly,lackingawarenessoftimeorplace,displayinghostileandcombativebehavior,hallucinating,regressinginbehavior,paylessintentiontopersonalhygiene,andbeingunabletorespondtosimplecommandsorfollowinstructions.Confusionanddisorientationissometimesatemporarycondition.Stressand/ordepressionduetophysicalandpsychologicalchangesisonepossiblecause.Useofalcoholorchemicalsisanother.Kidneydisease,whichinterfereswith1electrolytebalance;respiratorydisease,whichdecreasesoxygen;orliverdisease,whichinterfereswithmetabolism,areothercauses.Elderlyindividualsarealsomoresensitivetomedications,anddrugscansometimesaccumulateinthebodyandcauseconfusionanddisorientation.Evenpoornutritionorlackoffluidintakecaninterferewithmentalability.Frequently,identificationandtreatmentofanyoftheseconditionsdecreasesandeveneliminatestheconfusionanddisorientation.Foeexample,changingamedicationorgivingitinsmallerdoesmayrestorenormalfunction.Diseaseand/ordamagetothebraincansometimesresultinchronicconfusionordisorientation.Acerebrovascularaccident,orstroke,whichdamagesbraincells,isonepossiblecause.Abloodclotcanobstructbloodflowtothebrain,oravesselcanruptureandcausehemorrhaginginthebrain.Arteriosclerosis,aconditioninwhichthewallsofbloodvesselsbecomethickandlosetheirelasticity,iscommonintheelderlyindividuals.Ifthevesselsbecomenarrowduetodepositsoffatandminerals,suchascalcium,theconditioniscalledatherosclerosis.Theseconditionscancausetransientischemicattacks(TIAs),orministrokes,whichresultintemporaryperiodsofdiminishedbloodflowtothebrain.Eachtimeanattackoccurs,moredamagetobraincellsresults.Dementia,alsocalledbrainsyndrome,isalossofmentalabilitycharacterizedbyadecreaseinintellectualability,lossofmemory,impairedjudgment,personalitychange,anddisorientation.Whenthesymptomsarecausedbyhighfever,kidneyinfection,dehydration,hypoxia(lackofoxygen),drugtoxicity,orothertreatableconditions,theconditioniscalledacute.Whenthesymptomsarecausedpermanent,irreversibledamagetobraincells,theconditioniscalledchronic.Cerebralvascularaccidents,arteriosclerosis,andTIAscanbecontributingcausestochronicdementia.Onemoderntheorysuggeststhatchronicdementiaiscausedbyeitheracompletelackoraninadequateamountofanenzyme.Whateverthecause,chronicdementiaisusuallyregardedasaprogressive,irreversibledisease.Alzheimer’sdisease2isaformofdementiathatcausesprogressivechangesinbraincells.Itcanoccurinindividualsasyoungas40yearsofage,butfrequentlyoccursinthoseintheirsixties.Thecauseisunknown,buttherearemanytheoriescurrentlybeingresearched.Ageneticdefect,amissingenzyme,toxiceffectsofaluminum,avirus,andthefaultymetabolismofglucosehaveallbeenimplicatedaspossiblecauses.Whateverthecauses,Alzheimer’sdiseaseisviewedasaterminal,incurablebraindiseaseusuallylastingfrom3to10years.Intheearlystages,theindividualexhibitsmemoryloss,moodandpersonalitychanges,depression,poorjudgment,confusionregardingtimeandplace,andanabilitytoplanandfollowthroughwithmanyactivitiesofdailyliving.Asthediseaseprogresses,nighttimerestlessnessoccurs,moodswingsbecomesfrequent,personalhygieneisignored,weightfluctuates,paranoiaandhallucinationsincrease,andfull-timesupervisionbecomesnecessary.Intheterminalstage,theindividualexperiencestotaldisorientationregardingperson,timeandplace;becomesincoherentandisunabletocommunicatewithwords;losescontrolofbladderandbowelfunctions;developsseizures;losesweightdespiteeatingabalanceddiet;becomestotallydependent;andfinally,lapsesintoacomaanddies.Deathisoftencausedbypneumonia,infections,andkidneyfailure.Progressthroughthevariousstagesofthisdiseasevariesamongindividuals.Whateverthecauseofconfusionordisorientation,certaincoursesofcareshouldbefollowed.Aprimaryconcernistoprovideasafeandsecureenvironment.Dangerousobjectssuchasdrugs,poisons,scissors,knives,andcleaningsolutionsshouldbekeptoutofreachandinalockedarea.Iftheindividualtendstowander,doorsandwindowsshouldbesecure.Followingthesameroutineisalsoimportant.Meals,baths,dressing,walks,andbedtimeeachoccuratapproximatelythesametimeeachday.Anychangeinroutinecancausestressandconfusion.Eventhoughtheindividualshouldbeencouragedtobeasactiveaspossible,activitiesshouldbekeptsimpleandlastforshortperiodsoftime.Acalm,quietenvironmentisalsoimportant.Loudnoises,crowdedrooms,andexcessivecommotioncancausetheindividualtobecomeagitatedandmoredisor