Healthy Ageing And Challenges To Health For Older Persons

Pathophysiology

Discuss about the Healthy Ageing And Challenges To Health For Older Persons.

The rate of aging in global population is increasing day by day. This phenomenon is occurring in a time when the scale and rate of man made changes in the environment is exceeding the highest levels of ecological limitations. According to World Health Organization  (2017), about 15% of adults aged 60 and over suffer from a mental disorder.

 The biophysical issues related to aging is not much discussed in the society however, the effects of such issues are life threatening in the elderly population of the society (Berryman et al 2012). The psychosocial approach as well, looks at these elderly people in relation with the combined influence of social factors surrounding environment, and psychosocial factors (Keefe et al 2013). These approach talks about these above-mentioned factors on the mental and physical wellness.

To discuss these issues, the critical analysis will discuss the case of Marika, who is in her 80’s and is suffering from several disorders such as osteoporosis, osteoarthritis, hypertension, falls, overweight and delirium as well. She is currently living in an old age care home and suffering from these biophysical and psychosocial issues. This critical analysis is going to discuss her issues about osteoporosis and osteoarthritis with a proper clinical intervention and care plan to help her age in a healthy way.

As Marika is suffering from osteoarthritis, osteoporosis, hypertension, falls, and delirium, the pathophysiology of osteoarthritis and osteoporosis has been discussed.

Pathophysiology of osteoarthritis- the cartridge is a unique tissue that has several compressive and viscoelastic properties that is imparted by its extracellular matrix. This cartridge is made up of type two collagen and proteoglycans (Sankar et al. 2013). In normal condition, this matrix undergoes a remodeling process in which, lower level of synthetic and degradative enzymes are formed, that balances the overall activities and the volume of the cartridge is maintained. However, in the case of Osteoarthritis, expression of those degradative enzymes becomes higher than that of the synthesizer enzymes, leading to the shift the balance in the favor of overall degradation of the bones. This leads to loss of collagen and proteoglycans from the matrix. Hence, the bones becomes weaker (Olivotto et al. 2015). Due to the loss of those two building blocks of cartridge, chondrocytes produces elevated amounts of proteoglycans and collagens, however as the disease continues, the synthesize outmatched the degradation and leads to fibrillations, cracklings and erosions in the superficial layer of cartilage. These cracklings progresses to the deeper layers over time leading to clinically observable cracklings and erosions (Pesesse et al. 2014).

Investigation and tests

Pathophysiology of Osteoporosis –

The condition of osteoporosis is mainly the reduction in skeletal mass that has been caused by the imbalance between bone reabsorption and bone formation. In normal physiological conditions, the reabsorption and the bone formation are present in balance however; increase or decrease in either factor can lead to the condition of osteoporosis (Armas and Recker 2012). The cause of osteoporosis can be failure in the formation of bones and reaching the peak bone mass, during the young age, that causes loss of bones in the later period of life. Hormonal status can be another factor to cause osteoporosis. Aging and the loss in the gonadal functions are also the reasons behind the occurrence of the osteoporosis. As the menopause occurs, the rate of bone loss accelerates in women. Estrogen deficiency is a prime reason of the factors that influences the process of bone loss in elderly women (Drake, Clarke and Lewiecki 2015).

Due to these health problems, Marika is suffering from falls, delirium and hypertension.

Investigation of these diseases in Marika can be done using different pathophysiological tests. The diagnosis processes that can be used to investigate the level of osteoporosis are-

• Complete blood count test should be done to investigate the occurrence of anemia in Marika. In bone marrow, the level of cartridge determines the activities of bone reabsorption and bone formation. Hence, anemic patients can acquire this disease condition (Pisani et al. 2013).
• Serum chemistry tests to determine the levels of it in blood serum. However, if the patient is suffering from primary osteoporosis, the level will be normal in their serum.
• Hypercalciuria is another factor that can lead to the osteoporotic condition. Furthermore, the investigation, to determine the presence of intact para-thyroids and urine pH may indicate to these conditions. Hence, a 24-hour urine calcium or creatinine level is diagnosed to understand the reason for osteoporosis (Cosman et al. 2014).
• Serum protein electrophoresis can be done to determine the presence of multiple myeloma. Moreover, 25-hydroxyvitamin D level can be determined as the deficiency in this kind of protein can lead to the occurrence of the disorder.

Diagnosis procedures for the osteoarthritis can be-

• Magnetic resonance imagination or MRI and X-rays can be done to get a clear idea and image of the affected joints. However, cartilage cannot be seen through X-rays but the loss of cartilage can be observed by seeing the narrowing of the space between joint bones. MRI used radio waves and a magnetic fields to generate a detailed image of the bone and the tissues that are been affected by the presence of osteoarthritis (Aicher and Rolauffs 2014).
• Other than these imaging tests, different lab tests should be performed to understand the co-morbid situations of the presence of this disease. Joint fluid analysis is such a test that determines the fluid present in joints. The diagnosis includes extraction of fluid from the joints to determine the cause of inflammation is due to either infection or some other physiological condition (Loeser et al. 2012).

The primary signs and symptoms for Marika’s osteoarthritis included-

• Pain, the joint s of Marika used to hurt during and after movements. The pain became adverse with every day passing.
• Tenderness and stiffness in the joints. She used to feel tenderness in her joints while applying minimal pressure to it. She also felt stiffness after inactivity and waking up in the morning.
• Loss of flexibility and bone spurs were her secondary signs and symptoms for osteoarthritis (Aaseth, Boivin and Andersen 2012).

Symptoms of osteoporosis includes –

• Acute pain in the joints occurs after her fall. After this, she became prone to falls. The history of falls has caused the incidences of deliriums (Braun and Gold 2012).
• She was suffering from sharp pain in her joints and paravertebral muscle spasms that decreased when was lying and increases during activities. Hence, osteoporosis was detected.
• The pain was localized in the vertebral level and in lower thoracic (Castañeda et al. 2013).

The clinical course of osteoporosis and osteoarthritis can be better understood by Marika’s history of diseases. There are three levels for the etiopathogenesis of osteoarthritis. Marika is currently suffering from acute phase of arthritis hence; her pain is of the sharp level and cannot be controlled by physiotherapies of medication. In early stages the joint were appearing normal and was little tender and stiff while inactive. However, due to several course of falls. The pain become inevitable and joints become weaker (Pisters et al. 2012).

As per her symptoms. Marika is suffering from acute phase of osteoporosis as well. The MRI and X-ray reports has cleared the fact that her bone has become narrower due to the loss of calcium and several pores are present in it. Initially her pain used to be controlled by some analgesics; however, nowadays it has become intolerable.

Osteoporosis

• The most common treatment for osteoporosis involves bisphosphonates that are the most common kind of medication that has been provided to a patient of osteoporosis. The drugs that are commonly used are Alendronate, Risedronate, Ibandronate and Zoledronic acid. Hormones also plays an important role in the occurrence of the osteoporosis, hence ingestion of small amount of hormones are also prescribed.
• Denosumab are recent invented drugs that are currently used in the osteoporosis that reduces the risk associated with this disease (Das and Crockett 2013).

Osteoarthritis

• Acetaminophin are drugs that are currently been used to control the pain in the acute phase of osteoarthritis. These drugs are superior to NSAIDs that are primary pain relief medication provided.
• NSAIDs or non-steroidal anti-inflammatory agents are drugs that are used to limit the adverse pain in the osteoarthritis. It inhibits the prostaglandin generating enzyme COX that leads to decrease in the inflammatory symptoms leading to decreased pain.
• Another major medication that has been used commonly to reduce the pain in osteoarthritis are COX-2 inhibitors. It also inhibits the prostaglandin synthase enzyme leading to the decrease in the inflammatory symptoms (Sinusas 2012).

Conclusion

Aging is the most difficult phase for human being as the dependency on others affect the elderly people more effectively than any other health condition. Furthermore, presence of adverse health conditions increases their dependency, leading to hypertension. Marika lives in an old age care home and is suffering from several diseases. Due to the level of dependency, she is suffering from hypertension, which is the prime reason for her overweight body. She has a history of falls and due to which she used to feel severe pain in her joints. This is later diagnosed as osteoporosis and osteoarthritis of acute level. In this critical analysis, the sign, symptoms and the diagnosis process for her disease has been mentioned. Current medication that are being used to treat these bone disease has been discussed. The pathophysiology has also been discussed. A detailed care plan, including the interventions, goals and objectives, rationale and evaluation for these interventions has been mentioned in a tabular format that has been attached in the appendix section.

Clinical manifestation

References

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Pesesse, L., Sanchez, C., Walsh, D.A., Delcour, J.P., Baudouin, C., Msika, P. and Henrotin, Y., 2014. Bone sialoprotein as a potential key factor implicated in the pathophysiology of osteoarthritis. Osteoarthritis and cartilage, 22(4), pp.547-556.

Pisani, P., Renna, M.D., Conversano, F., Casciaro, E., Muratore, M., Quarta, E., Di Paola, M. and Casciaro, S., 2013. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World journal of radiology, 5(11), p.398.

Pisters, M.F., Veenhof, C., Van Dijk, G.M., Heymans, M.W., Twisk, J.W.R. and Dekker, J., 2012. The course of limitations in activities over 5 years in patients with knee and hip osteoarthritis with moderate functional limitations: risk factors for future functional decline. Osteoarthritis and cartilage, 20(6), pp.503-510.

Sankar, W.N., Nevitt, M., Parvizi, J., Felson, D.T. and Leunig, M., 2013. Femoroacetabular impingement: defining the condition and its role in the pathophysiology of osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons, 21, pp.S7-S15.

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