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Gout is more prevalent among older people Gout results from accumulation of uric acid crystals in joint spaces – often affecting the toe but also the foot, knee, ankle, hand or wrist – and the synovial lining, which triggers inflammation. It presents with sudden bouts of extreme pain, usually when sleeping. Patients cannot tolerate the weight of bedclothes and may have flu-like symptoms. Acute gout is self-limiting, resolving spontaneously in between three and 14 days, but it can become chronic with persistently stiff, swollen joints and crystal deposits under the skin forming white, painless lumps called trophi. The crystals result from under-excretion or over-production of uric acid. Over-production is associated with a diet high in purines found in animal protein, beer and spirits. The prevalence of gout increases with age because conditions such as obesity, diabetes and hypertension alter the metabolism of uric acid. Diuretics, lipid-lowering agents and antihypertensives can reduce kidney function. Burbage G (2014) Gout: clinical presentation and management. Nursing Standard. 29, 2, 50-56.
Pros and cons of drugs for motor symptom control Drug groups for control of motor symptoms in Parkinson’s disease are: dopamine agonists, levodopa, enzyme inhibitors, glutamate antagonists, and anticholinergics. Dopamine agonists stimulate dopamine receptors. These drugs can cause problems with impulse control, such as hypersexuality, gambling and reckless generosity, and should be used with caution in older patients because they may cause cognitive impairment. Levodopa crosses the blood-brain barrier to be converted to dopamine. Long-term use can cause dyskinesia or involuntary movements. Enzyme inhibitors selegiline and rasagiline stop the enzyme monoamine-oxidase-B breaking down dopamine and catecholNURSING OLDER PEOPLE
Alamy
Journal scan with prescription medications. For example, vitamin E and gingko biloba can increase the risk of bleeding and should not be used with anticoagulants. This review found that vitamin D and vitamin B12 can be useful in patients with low levels of these substances. There is some promising evidence for vitamin E, gingko biloba and omega-3 fatty acids, but it is not enough to warrant clinical use. Ford J, Brandt N (2014) Role of nutraceuticals in dementia care. Journal of Gerontological Nursing. 40, 4, 11-17.
Autogenic training shows short-term benefits in patients with early Parkinson’s disease
Training patients with Parkinson’s in autogenic exercises helped to relax their muscles and reduce rigidity
O-methyltransferase inhibitors, which are prescribed with levodopa to prolong its action. The glutamate antagonist, amantadine, is used to treat dyskinesia but it can cause hallucinations, postural hypotension and swollen legs, while stopping it abruptly can cause delirium and paranoia. Anticholinergics should be avoided in older people, who are more susceptible to neuropsychiatric symptoms. Magennis B, Lynch T, Corry M (2014) Current trends in the medical management of Parkinson’s disease: implications for nursing practice. British Journal of Neuroscience Nursing. 10, 2, 67-74.
Taking supplements is clinically unwarranted in dementia care Substances including B vitamins, vitamin D, vitamin E, omega-3 fatty acids and gingko biloba are often consumed in the hope of combating memory complaints and treating dementia. These supplements may seem innocuous, but there is a possibility of drug interactions if they are used in combination
A trial of people with early Parkinson’s disease compared 32 having physiotherapy with a similar number who had an additional 15 minutes of autogenic training (AT). Autogenic refers to the way the mind may influence the body. The first exercise aimed to relax participants’ muscles by repeating the phrase ‘my arm is heavy’. Later exercises focused on ‘my heartbeat is calm and regular’, and a feeling of ‘warmth around the abdomen’ and a forehead that is ‘cool and clear’. The AT group showed significant improvements in terms of facial expression, rigidity, resting tremor and hand movement when compared with the physiotherapy-only group. However, positive effects were less evident when tested four weeks later. The authors conclude AT is a useful adjunct to physiotherapy but it does not have long-lasting effects once discontinued. Ajimsha M, Majeed N, Chinnavan E et al (2014) Effectiveness of autogenic training in improving motor performances in Parkinson’s disease. Complementary Therapies in Medicine. 22, 3, 419-425. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person November 2014 | Volume 26 | Number 9 13
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Gout is more prevalent among older people Gout results from accumulation of uric acid crystals in joint spaces – often affecting the toe but also the foot, knee, ankle, hand or wrist – and the synovial lining, which triggers inflammation. It presents with sudden bouts of extreme pain, usually when sleeping. Patients cannot tolerate the weight of bedclothes and may have flu-like symptoms. Acute gout is self-limiting, resolving spontaneously in between three and 14 days, but it can become chronic with persistently stiff, swollen joints and crystal deposits under the skin forming white, painless lumps called trophi. The crystals result from under-excretion or over-production of uric acid. Over-production is associated with a diet high in purines found in animal protein, beer and spirits. The prevalence of gout increases with age because conditions such as obesity, diabetes and hypertension alter the metabolism of uric acid. Diuretics, lipid-lowering agents and antihypertensives can reduce kidney function. Burbage G (2014) Gout: clinical presentation and management. Nursing Standard. 29, 2, 50-56.
Pros and cons of drugs for motor symptom control Drug groups for control of motor symptoms in Parkinson’s disease are: dopamine agonists, levodopa, enzyme inhibitors, glutamate antagonists, and anticholinergics. Dopamine agonists stimulate dopamine receptors. These drugs can cause problems with impulse control, such as hypersexuality, gambling and reckless generosity, and should be used with caution in older patients because they may cause cognitive impairment. Levodopa crosses the blood-brain barrier to be converted to dopamine. Long-term use can cause dyskinesia or involuntary movements. Enzyme inhibitors selegiline and rasagiline stop the enzyme monoamine-oxidase-B breaking down dopamine and catecholNURSING OLDER PEOPLE
Alamy
Journal scan with prescription medications. For example, vitamin E and gingko biloba can increase the risk of bleeding and should not be used with anticoagulants. This review found that vitamin D and vitamin B12 can be useful in patients with low levels of these substances. There is some promising evidence for vitamin E, gingko biloba and omega-3 fatty acids, but it is not enough to warrant clinical use. Ford J, Brandt N (2014) Role of nutraceuticals in dementia care. Journal of Gerontological Nursing. 40, 4, 11-17.
Autogenic training shows short-term benefits in patients with early Parkinson’s disease
Training patients with Parkinson’s in autogenic exercises helped to relax their muscles and reduce rigidity
O-methyltransferase inhibitors, which are prescribed with levodopa to prolong its action. The glutamate antagonist, amantadine, is used to treat dyskinesia but it can cause hallucinations, postural hypotension and swollen legs, while stopping it abruptly can cause delirium and paranoia. Anticholinergics should be avoided in older people, who are more susceptible to neuropsychiatric symptoms. Magennis B, Lynch T, Corry M (2014) Current trends in the medical management of Parkinson’s disease: implications for nursing practice. British Journal of Neuroscience Nursing. 10, 2, 67-74.
Taking supplements is clinically unwarranted in dementia care Substances including B vitamins, vitamin D, vitamin E, omega-3 fatty acids and gingko biloba are often consumed in the hope of combating memory complaints and treating dementia. These supplements may seem innocuous, but there is a possibility of drug interactions if they are used in combination
A trial of people with early Parkinson’s disease compared 32 having physiotherapy with a similar number who had an additional 15 minutes of autogenic training (AT). Autogenic refers to the way the mind may influence the body. The first exercise aimed to relax participants’ muscles by repeating the phrase ‘my arm is heavy’. Later exercises focused on ‘my heartbeat is calm and regular’, and a feeling of ‘warmth around the abdomen’ and a forehead that is ‘cool and clear’. The AT group showed significant improvements in terms of facial expression, rigidity, resting tremor and hand movement when compared with the physiotherapy-only group. However, positive effects were less evident when tested four weeks later. The authors conclude AT is a useful adjunct to physiotherapy but it does not have long-lasting effects once discontinued. Ajimsha M, Majeed N, Chinnavan E et al (2014) Effectiveness of autogenic training in improving motor performances in Parkinson’s disease. Complementary Therapies in Medicine. 22, 3, 419-425. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person November 2014 | Volume 26 | Number 9 13
Downloaded from rcnpublishing.com by ${individualUser.displayName} on Jan 09, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCN Publishing Ltd. All rights reserved.
