The Care of the Adult Population

Musculoskeletal, assessment, changes according to age

For decades, one of the focuses of musculoskeletal studies has been the attempt to understand the changes of the musculoskeletal system associated with aging. Two major aspects should be addressed: muscle mass and muscle strength (Mitchell et al., 2015).The decline in muscle mass is known as sarcopenia, and the decline in muscle strength is known as dynapenia, and the latter is recognized today as a more significant factor that prevents people from “active and healthy aging” (Mitchell et al., 2015, p. 39).

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To examine physiological developments contributing to the decline in muscle size and muscle strength, the concept of muscle quality was proposed, which is measured by the capacity of force generated by muscles. At age 75 years, mass is lost at a rate of 0.67 percent in average for women and 0.89 percent in average for men, while strength is lost at a rate of 2.8 percent in average for women and 3.5 percent in average for men. The studies definitively confirm that strength is lost more rapidly, which allows qualifying the loss of muscle strength as a more significant factor in disabilities and death risks than the loss of muscle mass.

Osteoporosis and nutrition what is a functional assessment and benefits in the care of the adult population

Osteoporosis is a medical condition where bones become more fragile, and it is essentially linked to nutrition. One of the main causes of osteoporosis is a deficiency of calcium and vitamin D, which individuals normally receive with food (Cosman et al., 2014). Therefore, a special diet should be advised as an integral part of treatment, and it should include such products as low-fat dairy, fruits, and vegetables. There are various approaches to designing osteoporosis treatment, which is why “potential risks and benefits of all osteoporosis interventions should be reviewed with patients and the unique concerns and expectations of individual patients considered in any final therapeutic decision” (Cosman et al., 2014, p. 2362). However, adequate intake of calcium and vitamin D is a universal recommendation, as it is crucial for maintaining appropriate bone health. In adult patients, intake of calcium should be increased with advancing age because the risk of osteoporosis grows. At age 50 years and older, patients should consume approximately 1,000 mg of calcium per day, and at age 70 years and older, the norm should be increased to 1,200 mg per day. Excess is not recommended because it contributes to the risks of kidney stones and stroke.

The CAGE questionnaire is a good screening tool for ETOH, explain why and how benefit or complement a functional assessment

The CAGE questionnaire is a convenient tool for identifying signs of alcoholism and detecting the need for treatment. Its primary benefits include a short time of administering (normally less than one minute) and a wide context of applicability, i.e. there are not specific population-based characteristics that need to be taken into consideration, and the questionnaire can be applied to people with various backgrounds (Williams, 2014). The main strength of the CAGE questionnaire is that it is valid and reliable, as the questions are based on alcoholism studies and represent four conditions (experiences) that a person who is likely to be diagnosed with alcoholism is expected to have. A person is asked to answer whether he or she has ever felt the need to cut down on drinking, whether people around have ever annoyed him or her by criticizing his or her drinking, whether the person has felt guilty about drinking, and whether he or she has felt the need to have a drink first thing in the morning. More than two “yes” answers indicate the need for clinical attention. From the perspective of functional assessment, the questionnaire is particularly relevant because it appeals to behaviors and links them to potential health problems.

Neurological assessment, best way of performing it, and common disorders

Neurological assessment may include such techniques as interviewing, arousal and awareness testing, pupillary assessment, cranial nerve testing, vital signs examination, arm and leg movement, bilateral comparison of pain and temperature sensation, and cerebellar function assessment (Stone, 2014). The best way of performing the assessment is by concluding all these techniques and ensuring that every aspect of neurological health is properly addressed. Interviewing is the first stage where such signals of neurological problems as headache, alteration in memory, confusion in thinking, disorientation, weakness, decreased senses, and tremors and twitches can be identified. Further, the assessment adopts more profound exploration methods with specific clinical tools to examine the medical condition of a patient. Common disorders include brain and spinal cord damage, neuropathy (causing weakness or numbness), seizure disorders, movement disorders (including Parkinson’s disease), sleep disorders, neurodegenerative diseases (including Alzheimer’s disease) (Kaufman, Geyer, & Milstein, 2016), and dysfunctions associated with such activities as speaking, writing, reading, or perceiving, retaining, and retrieving information.

Pain assessment in cancer patients, and how to address it properly

Cancer-related pain is a daunting problem because, with the variety of existing methods of addressing it, health care providers fail to eliminate pain in approximately 75 percent of cancer cases (Stewart, 2014). Cancer pain is a complex phenomenon, and there is no single way of approaching it. It is suggested by researchers that one of the main causes of ineffective pain management in these cases is inadequate or incomplete pain assessment. Challenges of such assessment include multiple pain mechanisms and individual differences. Different types of pain often coexist, and it is hard to differentiate between neuropathic and nociceptive pain, which, in turn, makes it difficult to manage pain. Also, measuring pain for the purpose of providing adequate amounts of medication is challenging due to the lack of objective testing and universal qualification. To address pain assessment properly, it is recommended to categorize pain with more scrutiny, standardize approaches, and employ computer-based tools and quantitative electro-physiological techniques.

References

Cosman, F., De Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 25(10), 2359-2381.

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Kaufman, D. M., Geyer, H. L., & Milstein, M. J. (2016). Kaufman’s clinical neurology for psychiatrists. Cambridge, MA: Elsevier Health Sciences.

Mitchell, W. K., Williams, J., Atherton, P., Larvin, M., Lund, J., & Narici, M. (2015). Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength: A quantitative review. Physiology and Pathophysiology of Musculoskeletal Aging, 3(1), 39-56.

Stewart, J. (2014). Challenges of cancer pain assessment. Ulster Medical Journal, 83(1), 44-46.

Stone, J. (2014). Functional neurological disorders: The neurological assessment as treatment. Clinical Neurophysiology, 44(4), 363-373.

Williams, N. (2014). The CAGE questionnaire. Occupational Medicine, 64(6), 473-474.

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