Gerontic Nursing Practice - Essay Example

Gerontology and Gerontic Nursing Practice Case Study: 76 years old Female with Diabetes and Hypertension Mrs. John Age/Sex: 76/F ID No.: APD1.00438973 Address: 54 Orchard Street TX 4563 USA Telephone: 765-876-987 Date of admission: 13 Feb. 2007 Date of Discharge: 26 Feb. 2007 Consultants: Dr. Smith Unit: Geriatrics Dr. Gordon Unit: Endocrinologist Dr. Walter Unit: Internal Medicine Dr. Martha Unit: Nutrition & Diet Diagnosis: Diabetes Mellitus Type II Hypertension Altered cognitive state Malnutrition History: Mrs. John is a 76 years old sedentary woman, who came with complaints of Diabetes Mellitus Type II, Malnutrition, Altered Cognitive State and Hypertension. Mrs. John is five foot three, 125 pounds; She has Diabetes M Type II with a Hemoglobin A1C of 7% and a Fasting blood sugar of 165. Clinical Examination: Blood group: 'A' positive Blood pressure of 170 over 100 Fasting blood sugar: 165 PP blood sugar: 244 Lipids profile: Total cholesterol: 264 S.Triglycerides: 346 HDL: 57 LDL: 173 SGPT: 52 SGGTP: 99 S. Uric acid: 7.9 Impression: 1. Diabetes Mellitus Type II (FBG-165/ PPBG- 244, Hb1AC-7%) 2. Hyperuricemia (S. Uric acid 7.9) 3. Hyperlipidemia (S. Cholesterol 264, S.Triglycerides 346, LDL 173) 4. Deranged Liver Enzymes (SGPT 52, SGGTP 99) 5. Altered cognitive state 6. Hypertension 7. Malnutrition Management for Mrs. John in Hospital: Patient was admitted with above mentioned complaints opinion of Dr. Smith (Sr. Consultant Geriatric) Dr. Gordon (Sr. Consultant Endocrinologist) Dr. Walter (Internal Medicine) Dr. Martha (Dietician)she was predominantly present with multiple diagnosis, she was subsequently started on conservative management: Healthy Aging Diabetes Management, Altered cognitive state Hypertension Advice on Malnutrition Mrs. John aged 76, was admitted with multidiagnosis of Diabetes, Malnutrition, Altered cognitive state and Hypertension. The blood pressure was 170/100 mm Hg; The heart rate 64 beats per minute, her height 5 feet 3 inches, and her weight 153 pounds. A general physical examination showed no abnormalities. Mrs. John was put under Gerontic Nursing care for older people. Geriatrics nurses' best represent the broad range of skills involved in nursing art and science. Older people are often present with multiple challenges including diseases, disabilities, social and psychological losses. This demands immense knowledge from nurses. (Wold G. H. 2004) Normal Aging changes in Mrs. John Aging is a constant, predictable process that involves growth and development of living organisms. Aging can't be avoided it varies from one person to another. Growing old depends on genes, environmental influences, and life style. Aging bring disease, there are marked changes when a person grows old like the body wrinkles, loss of muscle tone, hair loss or graying. Aging involves the steady decline of organ function and body systems. (Wanger, J. S.1999) Except in times of exertion or stress these changes may or not be noticeable. As one ages, it may take longer to respond to stimuli. After an illness, it takes longer to recuperate. Body changes associated with aging make Mrs. John more vulnerable to various diseases, the side effects and complications of medical treatment. Because of her aging process response time slows, it takes longer to adjust to environmental changes. The process of normal aging in the absence of disease is accompanied by a myriad of changes in body systems. Many of these alterations involve decline in functional reserve with a reduced response to stressors. Aging is also defined as a state of mind, which does not always keep pace with one's chronological age. The clinical presentation of these anatomical and physiological alterations is of critical importance in nursing assessment and care of Mrs. John. Normal age-associated changes must be differentiated from pathological processes in order to develop appropriate interventions (Hogstel, M. O. 2001) Normal changes can adversely impact health and functionality and require corrective strategies to adapt to the changes. Further, aging and illness can interact reciprocally, resulting in altered presentation of illness and response to treatment, as well as outcomes. (Ames, Bruce N. et al.1993) Health professionals involved in Mrs. Johns plan for care while hospitalized. Consultant Geriatrics or Anti-Aging: Dr. Smith (Sr. consultant) Aging is a state of mind, body, and spirit that does not always keep pace with chronological age. Counseling and health education on healthy aging given for longevity Internal Medicine: Dr. Walter prescribed medicines for Mrs. John Tab Cardace 5mg 1 OD for Hypertension Tab Zyloric 100 BD after meals for Hyperuricemia Tab Storfib for Hyperlipidemia Tab Donepezil 1 OD for Altered cognitive state Cap Becosule 1 OD Mrs. John had occasional memory lapses or forgetfulness Cognitive Symptoms of excessive stress in an individual are identified as loss of sense of humor, loss of memory. These symptoms are not disease specific and derive from neurobiological changes in areas of the brain and are influenced by the patient's interaction with the environment. (Allen, M H. 2000). Aging aids in forgetfulness and loss of common sense. She was prescribed Tab Donepezil Endocrinologist: Dr. Gordon (Sr. consultant) prescribed Tab Amaryl 1mg before breakfast and dinner. Tab Obimet 500 BD after breakfast and dinner for treatment for Mrs. John of Diabetes Mellitus Type II to control blood sugar levels and keep them as close to normal as possible and put her on diabetic diet. Diabetes if not controlled might cause damage to the blood vessels, nerves eyes, heart, kidneys and feet. The After-effects of diabetes and consequences of diabetes are serious. Many diabetics need amputations because of poor blood circulation in the limbs. Late onset eventually develops poor cardiac function, marked oedema and increases cardiovascular and general mortality rate. It effects neurologically, low blood sugar known as hypoglycemia at the brain can cause brain damage, with cognitive and psychosocial damage. (Perry, H. M. 1999). Healthy Aging: It is important thatnurses that were with Mrs. John have an adequate geriatric education. They have a responsibility to be knowledgeable about the differences between age-related changes in her and pathology so that appropriate interventions are started. Consequences when older people and professionals confuse pathologic conditions with normal aging are to overlook treatable conditions. Many times this confusion significantly harm older by people by not addressing changes that are actual signs of illness (Miller, C.2004) Differentiate natural aging changes so that main focus is on treatable conditions. Nurses need to be "in the know" about realities of aging. They need be able to differentiate between the truths about aging and the many myths and stereotypes that exist so that interactions with them must be based on a solid knowledge foundation. There are many age old myths prevalent for aging populations which are not true. As people grow older, their intelligence does not decline significantly. Personality never changes with age. Memory loss is a normal part of aging. It is not true that Clinical depression occurs more frequently in older than younger people. Most old people lose interest in and capacity for sexual relations is not true. Constipation doesn't increases in more people as they grow older. Retirement is not detrimental to health or that people frequently become ill or die soon after retirement. The modern family does takes care of its older people. Abuse of older people is a significant problem in the U.S. But it is true that older adults have the highest suicide rate of any age group. Many people make "age excuses" which is basically attributing problems such as forgetfulness to old age rather than illness and potentially treatable conditions. A 2002 study by Ryan and colleagues explored "age excuses" and found they often undermine the self-perception of older people and threaten self-esteem if the older person believed the excuse. (Ryan E. B et al 2002) Information on healthy aging explained to Mrs. John Mrs. John was counseled so that she was able to understand the reason for her admission that Aging, or the experience of growing older, is a universal experience that began when she was born and is completed at death. Aging is a state of mind, body, and spirit that does not always keep pace with chronological age. For healthy aging she was told that her attitude and how well she faces the normal changes, challenges and opportunities that arise in life is the best indicator of age. All of the changes that take place will not be positive. However, if she is prepared to meet these changes, she would increase her chances of aging well. (John R, Kane R L, 1998). She must accept the process of aging. Make the most out of what life has to offer. Accept the fact that she will age and embrace the sense of freedom and comfort that everyone should feel in later years. She must be aware of the normal changes associated with age. In order to distinguish between normal changes and disease, she must have regular check-ups. She was told that her physical and mental health is her most important possessions. She must not dwell on aches and pains. She must eat sensibly. A sensible diet is the cornerstone of prevention and an important means of maintaining good health in later years. Limit saturated fats to less than 10 percent of total calories. She must include plenty of fluids, fiber, vitamins and minerals in her daily diet. She was asked to engage in Regular Exercise. Barring any health reasons, to include exercise in her daily activities. Be sure to consult her healthcare provider before beginning any new exercise program. She was advised to join an exercise class designed for her age. Walking, no matter the pace, is one of the best ways to achieve physical fitness and burn off excess calories. When you walk, every part of your body is used, from your head to your toes. Walking results in healthier hearts and lungs. Mrs. John was also asked to develop interests, such as hobbies and crafts, and get involved with groups with shared interests. Seek rewarding projects, both with a group and alone. She should establish warm relationships and improve her present friendships and family ties. Maintaining positive relationships throughout our lifetime contributes significantly to our sense of well being. Research shows that the quality of our social supports has direct positive effects on our health and can buffer or reduce some of the health-related effects of aging. (Elizabeth J G, 2005) Health education incorporated into Mrs. John's plan. Some of the effects of aging can be slowed and even prevented. Prevention in later years requires participating in health education and health promotion activities designed to reduce the risk of disease. Prevention also involves engaging in interventions that improve outcomes in the event an illness does occur and includes efforts that reduce the risk of progressive disability and decline of function. In later life the goals of prevention also include maintaining function, vitality and quality of life. Life style strongly determines how well we age. Mrs. John was advised to follow these seven health practices for healthy aging and longevity. 1. Seven to eight hours of sleep at night. 2. Weight control 3.Exercise 4. Limited alcohol consumption 5. Not smoking 6. Eating breakfast 7. Seldom snacking Exercise has been shown to be an important means of preventing cardiovascular disease, falls, and depression. Walking was recommended to Mrs. John around the wards for 15 minutes in morning and evening. A dietary excess was controlled for Mrs. John. The recommended diet included calorie intake that is balanced against the amount of energy expended. Saturated fats were limited to less than 10 percent of the total calories. Using the recommended daily allowances, to have an adequate intake of fiber, minerals, vitamins and approximately 8 glasses or 64 ounces fluids.(Saman, Z., et al. 1992) As per American Heart Association evidence-based guidelines for women are concerned, Mrs. John falls into the high risk category which includes women with known Diabetes, Hypertension, Hyperuricemia and Hyperlipidemia. She has multiples risk factors at the same time. In the United States, among adult women, 8.7% have diabetes and 30% of individuals with diabetes are unaware of it. Women who do not have diabetes have had about a 25% reduction in their heart disease mortality over the past 30 years, whereas in contrast, women with diabetes have had about a 25% increase. In men and women with diabetes, the cause of death is overwhelmingly heart disease. About 55% of total deaths are due to heart disease and another 10% due to cerebral vascular disease. So that, certainly, in individuals with diabetes, prevention directed at reducing heart disease and cerebral vascular risk is key. Management of Diabetes Mellitus Type II in Mrs. John In glucose tolerance tests, the ability to utilize a glucose load declines with age. In many cases, this is not true diabetes and may be age-associated rather than age-related. It may be due to increased obesity and reduced physical exercise. It may be increase in pathologies that affect glucose tolerance, drug therapies or a rise in carbohydrate intake. Tissues in older people are often less sensitive to insulin and many older people may develop late-onset non-insulin dependent diabetes. The risk of late-onset diabetes increases with age, family history of diabetes, obesity or lack of exercise. (Perry, H. M. 1999). Aging changes in Mrs. John were reduced insulin secretion & increased insulin resistance for carbohydrate metabolism. There is estrogen decline in post-menopausal women with increased bone osteoclast activity. Fluid or electrolyte balance affected by decreased rennin-angiotension-aldosterone activity, increased atrial naturetic hormone. Body composition was affected by decreased growth hormone, altered glucocorticoid. There was decreased hormonal response. Mrs. John was assessed functionality, fall risk, hydration i.e. fluid intake/output, BP (orthostatic). Laboratory values e.g., fasting & post-prandial blood sugars were monitored. Care strategies for Mrs. John were education on management of Diabetes. Nutrition, carbohydrates, hydration, and safety were incorporated for Mrs. John. Management and treatment for Mrs. John of Diabetes Mellitus Type II was to control blood sugar levels by keeping them as close to normal as possible by medications and diabetic diet. Medication: She was given Tab Amaryl 1mg before breakfast and dinner. Tab Obimet 500 BD after breakfast and dinner. She was put on diabetic diet of 1060 calories along with exercise to help keep blood glucose levels under control. Healthy diets prevent the need for medicine. Walking only 30 minutes a day can lead to better glucose control. (Eileen McLaughlin) Management of Altered Cognition in Mrs. John Mrs. John had occasional memory lapses or forgetfulness. Cognitive Symptoms of excessive stress in an individual are identified as loss of sense of humor, loss of memory. Aging aids in forgetfulness and loss of common sense. A person lacks in clear thinking and indecisiveness. These may be associated with depression, stress, lack of sleep, and normal aging. Memory loss only becomes a problem when it is severe and interferes with daily living. She was agitated over minor changes in her daily regime. Disruption of her normal routine surfaced a previously undiagnosed dementia in the hospital. Aggression is common and often emergent behavioral manifestations of the patient with dementia. (Volicer, L, Hurley, A. 2003). These symptoms are not disease specific and derive from neurobiological changes in areas of the brain and are influenced by the patient's interaction with the environment. (Allen, M H. 2000) It is not unusual for patients with dementia to also be delirious. Agitation thus may be a manifestation of dementia alone, or it may be caused or made worse by delirium. (Teri, L, Logston, R, McCurry, S. 2002). There were significant aging changes in Mrs. John: As one ages in central nervous system, there is decrease in neurons, brain size, neurotransmitters. There was slow nerve impulse conduction and decreased peripheral nerve function. Implications of these are that thought processing, response to stimuli, reflexes are slowed. There is increased threshold for light touch and pain sensation. Patient has risk of poor balance, postural hypotension, falls, and injury. There also was great variation in cognitive function with aging. There was limited memory impairment and cognitive decline common. There was risk of mild cognitive impairment and dementia. Mrs. John was assessed on functionality, cognition, BP (orthostatic). Hazards in home environment were evaluated. Care-giver needs for home was assessed Care strategies: She was prescribed Tab Donepezil. She was given education on safety and avoidance of falls. Malnutrition in the elderly Aging adults are at risk for malnutrition. Estimates for malnutrition in older adults are 40-60% of hospitalized older adults are malnourished or at risk for malnutrition. (Institute of Medicine 2000). Aging adults who are malnourished are more likely to experience longer lengths of hospital stay, increased hospital costs, diminished muscle strength, poor wound healing, and development of pressure ulcers, infections, post-operative complications, death and functional impairment. Aging adults have little or no appetite, problems with eating or swallowing, eat inadequate servings of nutrients and eat fewer than two meals a day. Those who live alone lose desire to cook because of loneliness, appetite of widows' decreases. They have difficulty cooking due to disabilities. Poor oral health or dry mouth impairs ability to lubricate, masticate and swallow food. (Coleman, P 2002) Antidepressants, antihypertensive and bronchodilators contribute to xerostomia or dry mouth. Management of Malnutrition in Mrs. John Dietary intake of Mrs. John was assessed. Intake with a calorie count the dietary intake analysis was documented. Accurate weight and height through direct measurement was noted. Current weight and weight history was documented. Usual body weight, history of weight loss was noted. Whether intentional or unintentional and over what period of time the patient was under nutrition was also noted. (Alibhai, S.M.H 2005) Loss of 10lbs over a six-month period is a red flag indicating need for further assessment. BMI was calculated to determine if weight for height is within normal range 22-27, BMI below 22 is sign of under nutrition. (Nutrition Screening Initiative 2002) Care Strategies: Patient was referred to dieticians for under nutrition. Pharmacist was consulted to review patient's medications for possible drug-nutrient interactions. A multidisciplinary team was consulted specializing in nutrition. Daily requirements for Mrs. John included: 30 kcal per kg of body weight, with no more than 30% of calories from fat. 0.8 to 1 g/kg or protein per day (Carney, John, Ann 1994) Caloric, carbohydrate, protein and fat requirements may differ depending on the degree of malnutrition. (Beers, M H, ed. 2005). Mealtime rounds were monitored to determine how much food is consumed and whether assistance is needed. Family members were encouraged to visit at mealtimes and asked to bring favorite foods from home when appropriate. Small frequent meals suggested with adequate nutrients to help patients regain or maintain weight. Nutritional snacks provided. Analgesics and Antiemetics administered on a schedule to diminish the likelihood of pain or nausea during mealtimes. Avoid re-feeding syndrome. (Solomon, S.M., Kirby, D F 1990) Patient was monitored carefully the first week of aggressive nutritional repletion. Was assessed and corrected the electrolyte abnormalities. Mrs. John experienced improvement in indicators of nutritional status. There was gradual increase in weight over time. Weigh patient weekly to monitor trends in weight. Daily weights are useful for monitoring fluid status. Increase in anthropometric measures over time. Increase in visceral protein over time. Improve in functional status and general well-being. (DiMaria-Ghalili, R.A, Amella, E 2005) Medication required for Mrs. John Tab Amaryl 2 mg before BF Tab Obimet 500 BD after breakfast and dinner. Tab Zyloric 100 BD after meals Tab Cardace 5mg 1 OD Tab Donepezil, 1 OD Tab Storfib 1 hs Tab Becosule 1 hs Medication must be taken as prescribed. (Dresbach S, Mehta B 2001) Medications to treat high blood pressure with diabetes are Angiotensin-converting enzyme inhibitors, or ACE inhibitors, block the production of a body chemical that constricts the arteries. ACE inhibitors include Benazepril hydrochloride, Enalapril Maleate, and Quinapril hydrochloride. Diuretics, or water pills, help the body get rid of extra fluid and sodium. Common diuretics prescribed include Furosemide, hydrochlorothiazide, and Chlorthalidone Older adults in North America take vitamin supplements each day. The primary reasons cited for taking a daily multiple vitamins are that they enhance energy and well-being to help defend against degenerative diseases such as cancer, heart disease, osteoporosis and dementia. (Saman Z, et al. 1992) To help manage existing health conditions such as arthritis and diabetes and to slow the aging process. (Ames, Bruce N. et al.1993) Medications prescribed for treatment of Altered Cognition are Donepezil, Tacrine, and Rivastigmine. These medications are designed to improve memory by increasing the amount of acetylcholine in the body. Other medications, such as Risperidone or Quetiapine, may also be used to help behavioral problems such as hallucinations, delusions, or agitation. Some individuals with memory loss may also need medications for depression, anxiety, or insomnia. Discharge Summary of Mrs. John Name: Mrs. John Age/Sex: 76/F ID No.: APD1.00438973 Address: 54 Orchard Street TX 4563 USA Telephone: 765-876-987 Date of admission: 13 Feb. 2007 Date of Discharge: 26 Feb. 2007 Consultants: Dr. Smith (Geriatrics) Dr. Gordon (Endocrinologist) Dr. Walter (Internal Medicine) Dr. Martha (Dietician) Diagnosis: Diabetes Mellitus Type II Hypertension Altered cognitive state Malnutrition History: Mrs. John is a 76 years old sedentary woman, who came with complaints of Diabetes Mellitus Type II, Malnutrition, Altered Cognitive State and Hypertension. Mrs. John is five foot three, 125 pounds; she has Diabetes M Type II with a Hemoglobin A1C of 7% and a Fasting blood sugar of 165. Clinical Examination: Blood group: 'A' positive Blood pressure of 170/100 Fasting blood sugar: 165 PP blood sugar: 244 Lipids profile: Total Cholesterol: 264 S.Triglycerides: 346 HDL: 57 LDL: 173 SGPT: 52 SGGTP: 99 S. Uric acid: 7.9 Impression: 1. Diabetes Mellitus Type II (FBG-165/ PPBG- 244, Hb1AC-7%) 2. Hyperuricemia (S. Uric acid 7.9) 3. Hyperlipidemia (S. Cholesterol 264, S.Triglycerides 346, LDL 173) 4. Deranged Liver Enzymes (SGPT 52, SGGTP 99) 5. Altered Cognitive state 6. Hypertension 7. Malnutrition Management for Mrs. John in Hospital: Patient was admitted with above mentioned complaints opinion of Dr. Smith (Sr. Consultant Geriatric) Dr. Gordon (Sr. Consultant Endocrinologist) Dr. Walter (Internal Medicine) she was predominantly present with multiple diagnosis, she was subsequently started on conservative management: Healthy Aging Diabetes Altered cognitive state Hypertension Advice on Malnutrition. Patient showed improvement clinically and was discharged on following advice on discharge: Healthy Aging advice for Mrs. John: Seven health practices for a long healthy life for longevity were advised to practice. 1. Seven to eight hours of sleep at night. 2. Weight control 3. Exercise 4. Limited alcohol consumption 5. Not smoking 6. Eating breakfast 7. Seldom snacking Quitting smoking and cutting back on drinking alcohol has benefits at any age. They increase the life expectancy, reduce their risk of heart disease, and improve lung function and circulation. As people age they go through life changes that affect their mental health. Depression is a medical disorder, like diabetes, high blood pressure or heart disease. If you're feeling down most of the time, this may signal depression. Talk about it with your doctor. The changes that aging brings are a natural part of life. Take note of the changes in your body. Talk with your doctor about them. Have routine screening tests. Your lifestyle plays a large part in keeping you healthy and active. Take care of yourself mind and body to stay healthy and active for a long time to come. Dietary Advice: Low calorie, low saturated fat and High fiber diabetic diet. A well-balanced diet is the key to good health. Poor nutrition increases your risk of vitamin deficiency and related problems. Drink eight glasses of water a day to prevent constipation. Advice on physical activities: Adv PFT with Bronchodilator Practice relaxation techniques and yoga Regular walking 45 to 60 min/day Regular exercise is one of the best things you can do to promote better health. Exercise can help to lower your blood pressure and cholesterol level. It lowers your risk of heart disease, stroke and type 2 diabetes. It strengthens your heart, lungs and bones. It keeps a healthy weight, keep your joints flexible and muscles strong, give you more energy. It also reduces stress, anxiety and depression. And improve balance. Medication: To take medicine as prescribed. Do not skip dosages. Take medications at the right time. Do not stop taking the drug without talking to your doctor, even if you are feeling better. Tab Amaryl 2 mg before BF Tab Obimet 500 BD after breakfast and dinner. Tab Cardace 5mg 1 OD for Hypertension Tab Zyloric 100 BD after meals Tab Storfib 1 hs Tab Becosule 1 hs Multi Vitamins Supplement Other recommendations: Consider blood test for TSH and review with the reports. Repeat blood test for F & PP blood sugar after 15 days. Lipid profile SGPT, SGGTP, S. Uric acid after one month and review with results. References: Allen, MH. (2000).Managing the agitated psychotic patient: a reappraisal of the evidence. Journal of Clinical Psychiatry, 61 (supplement 14), pp 11-20. Allen, MH, Currier, GW, Hughes, DH, et al. (2001).The expert consensus guideline series: Treatment of behavioral emergencies. Postgraduate Medicine Special Report, pp. 1-88. Alibhai, S.M.H., Greenwood, C., & Payette, H. (2005). An approach to the management of unintentional weight loss in elderly people. Canadian Medical Association Journal, 172, 773-780. American Society for Parenteral and Enteral Nutrition. (2002). Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parenteral and Enteral Nutrition, 26 (1 Suppl), 1SA-138SA. Ames, Bruce N. et al. (1993) Oxidants, Antioxidants, and the Degenerative Diseases of Aging; Proceedings of the National Academy of Science, Vol. 90 September 1993, pp. 7915-22 Beers, M.H., ed. (2005). Protein-energy under nutrition. The Merck manual of geriatrics. 3rd ed. Retrieved 6/20/2005 from http://www.merck.com/mrkshared/mmg/sec8/ch61/ch61a.jsp Carney, John, Ann. (1994) Role of Protein Oxidation in Aging and in Age Associated Neurodegenerative Disease, Life Sciences, Vol. 55, No. 25-26 (1994), pp.1-7 Center on Aging Studies at the University of Missouri-Kansas City. http://cas.umkc.edu/cas/ Coleman, P. (2002). Improving oral health care for the frail elderly: A review of widespread problems and best practices. Geriatric Nursing, 23(4), 189-199. DiMaria-Ghalili, R.A. & Amella, E. (2005). Nutrition in older adults. American Journal of Nursing, 105, 3, 40-51. Access complete article at www.NursingCenter.com/AJNolderadults Eileen McLaughlin, (2002) Type 2 Diabetes Mellitus Reviewer: Kathleen A. MacNaughton, RN, BSN Date Reviewed: 09/30/02 Elizabeth Joyner Gothelf, Assistant Director (2005), Article based on "Aging Successfully" Office of Geriatric Medicine, and Field Service Professor of Family Medicine, University of Cincinnati College of Medicine Hogstel, M. O. (2001). Gerontology: Nursing care of the older adult. Albany, NY: Delmar Institute of Medicine. (2000). The role of nutrition in maintaining health in the nation's elderly: evaluating coverage of nutrition services for the Medicare population. Washington, DC: National Academies Press; 2000. John Rowe, M.D., Robert L. Kane, Ph.D. (1998). Aging Successfully Pantheon Books, New York Miller, C. (2004). Aging for Wellness in Older Adults: Theory and practice. 4th Ed New York: Lippincott, Williams & Williams Nutrition Screening Initiative (2002) Nutrition Statement of Principle Retrieved September 1, 2005 at http://www.eatright.org/Public/Files/nutrition(1).pdf Perry, H. M. (1999). The endocrinology of aging. Clinical Chemistry, 45, 1369-1376. Ryan, E. B., Bieman-Copland, S., Kwong See, S.T., Ellis, C. H., & Anas, A. P. (2002). Age Excuses: Conversational Management of Memory Failures in Older Adults. Journal of Gerontology, 57, 256- 267 Seidner, D.L. The science and practice of nutrition support. A case-based core curriculum (pp. 189-209). Dubuque, Iowa: Kendall/Hunt Publishing Company. Sereana Dresbach and Bella Mehta (2001) Gerontology The Central Ohio Area Agency on Aging Solomon, S.M., & Kirby, D.F. (1990) The refeeding syndrome: A review. Journal of Parenteral and Enteral Nutrition, 14, 90-97. Teasley- Strausburg, K.M. Nutritional/ Metabolic Assessment. In Teasley- Strausburg, K.M. (ed.). Nutrition Support Handbook; A Compendium of Products with Guidelines for Usage. Cincinnati, Ohio. Teri, L, Logston, R, McCurry, S. (2002). Nonpharmacological treatment of behavioral disturbance in dementia. Medical Clinics North America, 86, pp. 641-656. Volicer, L, Hurley, A. (2003). Management of behavioral symptoms in progressive degenerative dementias. Journal of Gerontology: Medical Sciences, 58A, pp. 837-845. Wanger, J. S. (1999, July 5). Assessment of the older adult with special emphasis on function. Greater Philadelphia Advance for Nurses, 19-22. Wold G. H. (2004) Basic Geriatric Nursing (3rd ed.). St. Louis, MO: Mosby, Inc. Weblink National Institute on Aging Research Programs page (http://www.nih.gov/nia/research/) American Federation for Aging Research (http://www.infoaging.org/) American Academy of Anti-Aging Medicine (http://www.worldhealth.net/) Gerontology Research Group (http://www.grg.org/) Read More