Farley, A 　著

内容

目次

Author profi les xiii Preface xv 1 Growing Older 1 Introduction 1 Drivers in the care of older adults 2 Activities of living 3 Overall aims 4 References 5 2 Theories of Ageing 7 Aims 7 Learning Outcomes 7 Introduction 7 Ageing theories 7 Error theory 8 Free radical theory 8 Immune theory 9 Programmed theory of ageing: changes in cell replication 10 Neuroendocrine theory 11 Effects of ageing on homeostasis and body function 11 Summary 12 References and further reading 13 3 Maintaining a Safe Environment 14 Aims 14 Learning Outcomes 14 Introduction 14 Immune system 15 Physical/mechanical and chemical barriers 15 Phagocytosis 15 Acute infl ammatory response 16 Typical immune response to the presence of pathogenic microorganisms 17 Relationship between innate (non–specifi c) and acquired (specifi c) immunity 17 Wound healing 18 Ageing changes in the immune system 19 Changes in the thymus 20 T cell function 20 B cell function 20 Natural killer cells 21 Infl ammatory process 21 Nutrition 22 Changes to the skin and mucous membranes 23 HIV/AIDS 24 Assessment of the immune system 24 HIV/AIDS 26 Stages of HIV infection 26 Modes of transmission related to older adults 26 Issues relating to older people and HIV/AIDS 27 Summary 29 References and further reading 30 Useful websites 31 4 Communicating 32 Aims 32 Learning Outcomes 32 Introduction 32 Normal structure and function 33 The nervous system 33 Ageing changes in the nervous system 39 Brain 39 Neuronal loss 39 Neuronal networks 40 Neurotransmitters 40 Lipofuscin and neurofi brillary tangles 41 Movement 41 Changes in the spinal cord 41 The eye 42 Structures of the eye 42 Aqueous humour and vitreous humour 43 Accessory structures 43 Physiology of vision 43 Refraction 44 Accommodation 44 Constriction 44 Convergence 44 Retina and the conversion of light to an electrical signal 44 Ageing changes in the eye 45 The ear 46 Normal structure and function 46 Physiology of sound 48 Ageing changes in hearing and vestibular function 49 Conditions associated with communication diffi culty in older adults 49 Delirium 49 Assessment for delirium 51 Management 52 Pain in older people 53 Epidemiology of pain for older people 53 Criteria for choosing a pain assessment tool 54 Other factors 58 Management of pain for older people 59 Parkinson's disease 59 Pathophysiology 60 Diagnosis 62 Medical management 62 Nursing management 63 Summary 64 References and further reading 64 Useful websites 66 5 Breathing 67 Aims 67 Learning Outcomes 67 Introduction 67 Normal structure and function 68 Upper respiratory tract 68 Lower respiratory tract 69 Mechanics of respiration 71 The mechanics of breathing 71 Inspiration 71 Expiration 72 Gas exchange 73 Oxygen and carbon dioxide transport 73 Control of breathing 73 Nervous system control 73 Chemical control 74 Ageing changes in the respiratory system 75 Changes in the structure of the respiratory tract 75 The thoracic cage and muscular function 76 Alveoli 76 Elastic recoil 77 Control of ventilation 77 Assessing respiratory function 78 Common respiratory problems associated with ageing 79 Pneumonia 79 Management of the older adult with pneumonia 80 Infl uenza 82 Cardiovascular system 84 Normal structure and function 84 Blood fl ow 85 Changes in the cardiovascular system of the older adult 86 Heart failure 86 Clinical features 87 Classifi cation of heart failure 87 Outlook 87 Management 87 Summary 88 References and further reading 89 Useful websites 90 6 Eating and Drinking 91 Aims 91 Learning Outcomes 91 Introduction 91 Normal structure and function 92 The mouth 93 The stomach 94 The small intestine 95 Absorption of nutrients in small intestine 96 The large intestine 98 The liver 99 The gall bladder 100 The pancreas 100 Ageing changes in the digestive system 101 Oral hygiene 103 Assessment of oral health 105 Nursing management of oral hygiene 105 Nutritional assessment 106 Common GI problems associated with ageing 110 Under–nutrition in older people 110 Food guide pyramid 111 Constipation 112 Summary 116 References and further reading 117 Useful websites 119 7 Eliminating 120 Aims 120 Learning outcomes 120 Introduction 120 Normal structure and function of the urinary system 121 Blood supply to the kidneys 121 Renin???angiotensin mechanism 124 The bladder 124 The urethra 125 Micturition 125 Ageing changes in the urinary system 125 Glomerular fi ltration rate 126 Creatinine 126 Day/night changes in renal function 126 Hormones 127 Common problems of the urinary system 128 Urinary incontinence 128 Urinary tract infection 130 Assessment of continence 132 The urogenital distress inventory 134 Long form of UDI 134 Short form of UDI 135 Management of urinary incontinence 136 Scheduled voiding 137 Prompted voiding 137 Bladder training 137 Pelvic muscle exercises 137 Intermittent catheterisation 138 Summary 139 References and further reading 139 Useful websites 141 8 Controlling Body Temperature 142 Aims 142 Learning Outcomes 142 Introduction 142 Normal structure and function 142 Structure of the skin 143 Gaining and losing heat 143 The effects of ageing on the ability to maintain body temperature 145 Epidermal changes with ageing 145 Conditions affecting thermoregulation in older adults 148 Hypothermia 148 Prevention of hypothermia 149 Acute management of hypothermia 153 Re–warming techniques 154 Heat stroke 155 Summary 155 References and further reading 156 Useful websites 157 9 Mobilising 158 Aims 158 Learning Outcomes 158 Introduction 158 Normal structure and function 159 The locomotor system 159 Control of skeletal muscles 162 Ageing changes related to mobilising 162 Bones 162 Joints 164 Muscles 164 Age–related health problems 166 Osteoporosis 166 Falls in older people 167 Falls risk assessment 169 Interventions 170 Preventative measures 172 Exercise 173 Summary 174 References and further reading 175 Useful websites 176 10 Expressing Sexuality 177 Aims 177 Learning Outcomes 177 Introduction 177 Male reproductive system 178 Normal structure and function 178 General function 179 Sexual arousal and ejaculation 180 Female reproductive system 181 Ovaries 181 The menstrual cycle 181 Meiosis 181 The fallopian tubes 182 The uterus 182 The vagina 182 The external genitalia 183 Breasts 183 Sexual arousal in females 183 Changes in the reproductive systems associated with ageing 184 Maintaining sexuality 184 The ageing man 184 Testosterone 184 Sperm production 185 Changes in sexual arousal 185 The ageing woman 185 Hormonal changes related to the menopause 185 Effects of the hormonal changes on the female body 186 Sexual arousal in older women 187 Sexuality in older people 187 Factors affecting sexuality in older people 190 Assessment of sexual function 191 Permission giving 191 Limited information stage 192 Specifi c suggestions stage 192 Intensive therapy stage 192 Management of health issues related to sexuality 193 Summary 193 References and further reading 194 11 Sleeping 195 Aims 195 Learning Outcomes 195 Introduction 195 The normal sleep cycle 195 Ageing changes with sleeping associated with the sleep???wake cycle 197 Assessment of sleep 199 Sleep disorders in older adults 200 Apnoea 200 Leg movements during sleep 201 Insomnia 201 REM sleep disorder 202 General interventions 203 Specifi c interventions 205 Summary 205 References and further reading 206 12 Final Thoughts on Ageing 207 Index 209