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(BQ) Part 1 book Murtagh''s patient education presents the following contents: Stages of human development (Marriage, pregnancy and postnatal care, children’s health, adolescent health, women’s health, men’s health, the elderly).
Murtagh’s PATIENT EDUCATION To my wife, Jill, and our children, Paul, Julie, Caroline, Luke and Clare, for their understanding, patience and support Murtagh’s patient education 6e John Murtagh AM MBBS, MD, BSc, BEd, FRACGP, DipObstRCOG Emeritus Professor in General Practice, School of Primary Health Care, Monash University, Melbourne Professorial Fellow, Department of General Practice, University of Melbourne Adjunct Clinical Professor, Graduate School of Medicine, University of Notre Dame, Fremantle, Western Australia Guest Professor, Peking University, Health Science Centre, Beijing iii NOTICE Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the editors, nor the publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete Readers are encouraged to confirm the information contained herein with other sources For example, and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this book is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs First edition 1992 Second edition 1996 Third edition 2000 Reprinted 2001 Fourth edition 2005 Fifth edition 2008, reprinted 2009 Sixth edition 2012 Text © 2008 John Murtagh Illustrations and design © 2008 McGraw-Hill Australia Pty Ltd Additional owners of copyright are named in on-page credits and on the acknowledgments page Every effort has been made to trace and acknowledge copyright material Should any infringement have occurred accidentally the authors and publishers tender their apologies Reproduction and communication for educational purposes The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of the pages of this work, whichever is the greater, to be reproduced and/ or communicated by any educational institution for its educational purposes provided that the institution (or the body that administers it) has sent a Statutory Educational notice to Copyright Agency Limited (CAL) and been granted a licence For details of statutory educational and other copyright licences contact: Copyright Agency Limited, Level 15, 233 Castlereagh Street, Sydney NSW 2000 Telephone: (02) 9394 7600 Website: www.copyright.com.au Reproduction and communication for other purposes Apart from any fair dealing for the purposes of study, research, criticism or review, as permitted under the Act, no part of this publication may be reproduced, distributed or transmitted in any form or by any means, or stored in a database or retrieval system, without the written permission of McGraw-Hill Australia including, but not limited to, any network or other electronic storage Enquiries should be made to the publisher via www.mcgraw-hill.com.au or marked for the attention of the Rights and Permissions Manager at the address below Enquiries concerning copyright in McGraw-Hill publications should be directed to the Permissions Editor at the address below National Library of Australia Cataloguing-in-Publication data Murtagh, John John Murtagh’s patient education / John Murtagh 6th edition ISBN 9781743070109 (pbk.) Includes index Previous ed.: 2008 Patient education Family medicine 615.5071 Published in Australia by McGraw-Hill Australia Pty Ltd Level 2, 82 Waterloo Road, North Ryde NSW 2113 Associate editor: Fiona Richardson Senior production editor: Yani Silvana Editor: Nicole McKenzie Proofreaders: Rosemary Moore, Carol Natsis Indexer: Shelley Barons Cover design: George Creative Internal design: Dominic Giustarini Illustrator: Aptara Inc., New Delhi, India/ diacriTech, India Typeset in JoannaMT 10/11 by diacriTech, India Printed in China on 80 gsm woodfree by China Translation and Printing Services Ltd Foreword During my student days in the late 1940s the idea of educating patients about their illnesses was never discussed From memory I am not aware that this omission was even noticed, although it may have been by those students who were wiser and more broadly educated than myself When later I began medical practice as a solo general practitioner, I remember being surprised by the number of patients who had had major surgical procedures (as judged by their obvious scars) and who were quite ignorant of these procedures or what organs they no longer possessed I found this lack of available information often interfered with the process of diagnosis due to incomplete, and often highly relevant, past medical history Another memory of my early years in practice was the number of times I was called out of bed because a child had a fever, only to be met on arrival at the home by a mildly ill child playing with a box of toys This provided sufficient motivation to start teaching the family about the relative unimportance of a single sign in assessing illness severity, and the need to look at the whole child and not just the thermometer reading Within two years, despite an increasing population of children in a new suburb, there were two observable results First, the number of such requests for night and weekend calls had markedly reduced and, second, there was positive feedback from patients, such as ‘Thank you for giving your time to explain things to me’ At the time many general practitioners were learning that this educational role was a legitimate and important part of being a competent general practitioner, which is not surprising since the word ‘doctor’ originally meant ‘teacher’ When I moved to academia, I then had a chance, together with my colleagues, to develop these ideas further and to formalise patient education as an essential part of patient management in the context of today’s society Patient education now forms a major part of a formal undergraduate teaching program embracing a number of consulting skills In addition to the verbal communication skills of this program, we have developed a matching series of take-home pamphlets to reinforce these educational messages John Murtagh has taken up the concept of extending the consultation by writing patient handouts focusing on illnesses and their management These have been published over many years in Australian Family Physician, and adopted for use by many general practitioners during the consultation They have been gathered together and rewritten in this format for use by doctors and other health professionals as an aid to improving quality of care, reducing its costs and encouraging a greater input by patients in the management of their own illnesses The unique objective of this publication is the author’s wish to encourage doctors to use the material and to photocopy or even modify those hand-outs considered most useful A logical extension of this information is to use it in an electronic format; Patient Education is also available on computer software Many doctors, especially younger doctors and medical students, have claimed that Patient Education has been a helpful form of doctor education and very useful in preparation for examinations, both undergraduate and for the fellowship of the Royal Australian College of General Practitioners In a society where informed consent is increasingly expected by the public, and the legal profession in particular, it is important for doctors to be aware of the need to provide patients and families with much more information than in the past Professor Murtagh is to be congratulated for producing the important messages in non-technical language within the confines of a single page This no doubt is a result of many years of experience in general practice, where he has learned the skills of effective communication EMERITUS PROFESSOR NEIL CARSON, MD, AO, Past Chairman, Department of Community Medicine and General Practice, Monash University, Melbourne v This page intentionally left blank Contents Foreword v About the author xiv Preface xv Acknowledgments xvi Part Stages of human development 1 Marriage Making your marriage work 2 Pregnancy and postnatal care Pregnancy planning About your pregnancy Breastfeeding and milk supply Establishing breastfeeding Mastitis with breastfeeding Miscarriage Nipple problems while breastfeeding Postnatal depression 10 Children’s health Allergy in your baby 11 Asthma in children 12 Atopic eczema 13 Attention deficit hyperactivity disorder 14 Autism 15 Autism: Asperger’s syndrome 16 Bed-wetting (enuresis) 17 Birthmarks 18 Bow legs and knock knees 19 Bronchiolitis 20 Bullying of children 21 Chickenpox (varicella) 22 Child accident prevention in the home 23 Circumcision 24 Coeliac disease in children 25 Croup 26 Crying baby 27 Down syndrome 28 Dyslexia and other SLDs 29 Earache in children 30 Encopresis 31 Febrile convulsions 32 Feeding your baby 33 Fever in children 34 Flat feet 35 Gastroenteritis in children 36 Glue ear 37 Growing pains 38 CONTENTS vii Hearing problems in children 39 Immunisation of children 40 Impetigo 41 Infant colic 42 Intoeing in children (pigeon toes) 43 Measles 44 Mumps 45 Nappy rash 46 Normal development in children 47 Peanut allergy 48 Rearing a happy child 49 Reflux in infants 50 Roseola 51 Rubella (German measles) 52 Scoliosis 53 Seborrhoea in infants 54 Slapped cheek disease 55 Sleep problems in children 56 Snuffling infant 57 Squint and loss of vision 58 Stuttering 59 Tantrums 60 Tear duct blockage 61 Teething 62 Testicle, undescended 63 Thumb sucking 64 Toilet training your child 65 Umbilical hernia 66 Urine infection in children 67 Viral skin rashes in children 68 Vulvovaginal irritation in children 69 Adolescent health Acne 70 Depression in teenagers 71 Eating disorders 72 Osgood–Schlatter disorder 73 Understanding the adolescent 74 Understanding your menstrual cycle 75 Women’s health Breast cancer 76 Breast lumps 77 Breast awareness and breast self-examination 78 Cystitis in women 79 Dysmenorrhoea (painful periods) 80 Endometriosis 81 Fibroids 82 Hair loss in women 83 Hirsutism 84 Incontinence of urine 85 Menopause 86 Menorrhagia (heavy periods) 87 Painful breasts 88 Pap test 89 Pelvic inflammatory disease 90 Pill: the combination pill 91 Polycystic ovary syndrome 92 Premenstrual syndrome 93 Tubal ligation 94 Vaginal thrush 95 viii CONTENTS Men’s health Erectile dysfunction (impotence) 96 Foreskin hygiene 97 Male pattern baldness 98 Prostate: prostate cancer 99 Prostate: prostatitis 100 Prostate: the test for prostate cancer 101 Prostate: your enlarged prostate 102 Prostate: your prostate operation 103 Scrotal lumps 104 Testicular cancer 105 Testicular self-examination (TSE) 106 Vasectomy 107 The elderly Arthritis in the elderly 108 Dementia 109 Eye problems in older people 110 Falls in older people 111 Hearing impairment in older people 112 Leg ulcers 113 Osteoporosis 114 Parkinson’s disease 115 Retirement planning 116 Stroke 117 Tinnitus 118 Part General health 119 8 Prevention Cardiovascular (including coronary) risk factors 120 Cholesterol: how to lower cholesterol 121 Diet guidelines for good health 122 Obesity: how to lose weight wisely 123 Smoking: quitting 124 9 Infections Bacterial meningitis and meningococcus 125 Bed bug bites 126 Bronchitis: acute bronchitis 127 Bronchitis: chronic bronchitis 128 Chlamydial urethritis 129 Common cold 130 Ear infection (otitis media) 131 Glandular fever 132 Gonorrhoea 133 Hand, foot and mouth disease 134 Hepatitis A 135 Hepatitis B 136 Hepatitis C 137 Herpes: genital herpes 138 Herpes simplex (cold sores) 139 Herpes zoster (shingles) 140 HIV infection and AIDS 141 Influenza 142 Labyrinthitis 143 Laryngitis 144 Lice: head lice 145 Lice: pubic lice 146 Malaria 147 CONTENTS ix Scrotal lumps The scrotum contains two testicles and their spermatic cords, plus muscle and other soft tissue Lumps that develop in the scrotum are quite common and cause anxiety when detected but most are not serious The lumps can be considered as: • solid, such as cancer of the testicle and orchitis (inflammation of the testicle) • fluid-filled (cystic), such as a cyst of the testicle and hydroceles • lumps coming down from the abdomen (e.g inguinal hernia) The lumps can be diagnosed by clinical examination plus ultrasound investigation, which gives an accurate diagnosis Any lump in the testicle should be investigated for cancer, which is an uncommon cause of a lump in the scrotum The common lumps are as follows Cyst of epididymis of testicle The epididymis is a sac that is connected to the testicle and lies just behind it These cysts are common and usually harmless Features • Usually in middle-aged to elderly men • Contains a clear fluid or sperm • May or may not cause discomfort: a dragging sensation Treatment No treatment is usually required and they can be left alone Surgical excision is advisable if uncomfortable or unsightly Needle aspiration is also an option Hydrocele A hydrocele is a large, soft swelling that completely surrounds the testicle Features • Caused by a collection of clear, sterile fluid • Can be huge in size • Often the cause is unknown but it may follow an injury or testicular cancer • Occurs in males of any age, especially baby boys and in older men • Usually causes no symptoms but may cause a dragging discomfort • Usually harmless and men learn to live with it Treatment A simple operation is the best way to remove a troublesome hydrocele In elderly men it is common to aspirate the fluid with a needle and syringe This can be repeated as necessary as a hydrocele tends to keep filling up with the serous fluid firm mass Testicular tumour cyst of epididymis testicle Cyst of epididymis Varicocele A varicocele is a soft swelling or lump that surrounds the testicle It is due to a large knot of varicose veins Features • Almost always on the left side • Caused by distension of the vein that drains the testicle, due to a faulty valve • Lump is more noticeable when standing, usually disappearing on lying down • May be no discomfort but some men feel a dragging discomfort, even pain, especially after exercise and in hot weather • Linked with infertility in men but not proven Treatment No treatment is necessary if it causes no discomfort Firm-fitting underpants or a jockstrap can be used for mild discomfort and swelling Surgery, which is straightforward, is recommended for significant discomfort or if associated with reduced size of the left testicle or with infertility 104 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL expanded veins Varicocele clear fluid Hydrocele Testicular cancer What are the facts about testicular cancer? What is the treatment? The testicles (testes) are two oval-shaped, firm organs located in the scrotum Cancer of the testicle is uncommon but nevertheless accounts for about to 2% of malignant tumours in men It mainly affects fit young men and is the most common malignancy in men aged 15 to 45 years Usually only one testicle is affected There are two main types of testicular cancer: • seminoma, which typically occurs between 25 and 50 years • non-seminoma, which typically occurs under 35 years (from 15 years onwards) The outlook is very good for most testicular cancers with a 5-year cure rate of 90 to 95%, especially if operated on at an early stage The gold standard of treatment is surgery (an orchidectomy) by a urologist through an incision just above the scrotum The results are particularly good for seminoma, which is very sensitive to treatment with radiotherapy Treatment methods include: • surgery to remove the testicle plus lymph glands if spread has occurred • radiotherapy, where X-rays are directed in a concentrated beam at lymph glands (very effective for seminoma and any remaining cancer cells) • chemotherapy with cancer-killing drugs—this is very effective for all types of testicular cancer but is used mainly for non-seminoma cancer What are the symptoms and signs? • • • • A lump in the testicle, which is usually painless Loss of sensation in the testicle Sensation of heaviness in the scrotum Possible ache or pain (in about 15% of men) There may be an associated swelling such as a hydrocele or an inflamed testicle What is the cause of testicular cancer? Abnormal cells form and multiply in an uncontrolled way to form the malignant tumour The exact cause is unknown but the known risk factors are: • an undescended testicle (5 times the risk) • an operation to ‘fix’ an undescended testicle • withering of the testicle (e.g following an infection) • family history of cancer of the testicle • previous cancer of the testicle • severe trauma to the testicle • prolonged heat exposure • Klinefelter syndrome (a genetic condition in which males have an extra x chromosome) • HIV/AIDS (may be a slightly higher risk) Follow-up management It is standard practice to perform CT scans of the chest, abdomen and pelvis regularly every few months in the first years and then less often after that Blood tests for special ‘marker’ chemicals released by the cancer, such as alpha-fetoprotein, are usually performed at each visit What are the after-effects of treatment? Sexual function is not usually affected The loss of one testicle has little effect on fertility, as the remaining testicle usually continues to make ample sperm vas deferens epididymis How is it diagnosed? The cancer is usually diagnosed by: • the person feeling a lump • his doctor examining the testicles and scrotum • ultrasound examination, which is very effective • blood tests called ‘tumour markers’ firm lump of testicular cancer testicle scrotum MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 105 Testicular self-examination (TSE) Why bother with TSE? How to TSE Although testicular cancer is rare, it is the most common cancer in men between the ages of 15 and 34 years With early detection and recent advances in chemotherapy, testicular cancer is one of the most easily cured cancers Some patients are only diagnosed after the tumour has well and truly spread into the body, but even these patients can respond well to modern treatment That’s why young men who are at risk of testicular cancer should carry out regular monthly self-examination of the testes Those at risk are those with: • a family history of testicular cancer • testicular atrophy (e.g mumps, trauma) • delayed repair of undescended testes • previous testicular cancer There is currently no evidence that regular self-examination of the testes prevents deaths from testicular cancer in young men who are not at risk of testicular cancer Nevertheless many doctors still recommend that all young men regular self-examination of their testes, regardless of whether they are at risk or not Being familiar with the look, feel and shape of your testes will help you detect any changes early, when the chances of a cure for testicular cancer are at their highest Testicular self-examination is a simple procedure The examination should be done about once a month, preferably after a warm bath or shower, when the scrotal skin is most relaxed Examination is best done using two hands, as illustrated • Using the palm of your hand, support your scrotum • Hold each testicle in the palm of your hand • Explore each testicle individually • Using both hands, gently roll the testicle between the thumbs and fingers The testicle should feel firm and the surface smooth If pain is experienced, too much pressure is being applied What are the causes of testicular cancer? They are not exactly known, but some factors that may lead to it are an undescended testicle, trauma (injury), heat exposure and heredity What to look for It is normal for one testicle to feel slightly bigger than the other and for the left one to hang lower than the right A normal testicle is egg-shaped, fairly firm to touch and should be smooth and free of lumps When you examine the testicles, you should feel for any changes in size, shape, weight or consistency If you find something abnormal, most likely it will be an area of firmness or small lump on the front or on the side of the testicle Do not confuse the epididymis (the soft coiled tube-like structure at the back of the testicle) with a tumour If you find something abnormal, you should see a doctor as soon as possible However, remember that not all lumps are due to cancer What are the symptoms? The usual symptoms of testicular cancer include a lump on the testicle, painless swelling and a dull ache or heavy dragging sensation in the lower abdomen, groin or scrotum The early symptoms are therefore mild and tend to be overlooked TSE technique 106 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL TSE is best performed after a warm bath or shower Vasectomy What is vasectomy? Does vasectomy affect sexual function? Vasectomy, which is the most common method of sterilisation in men, is an operation in which the two ‘vas’ tubes (the vas deferens) are cut and tied This blocks the flow of sperm from the testicles into the penis, so that when the man ejaculates the semen does not contain sperm No It makes no difference to a man’s sex drive and performance Some say that their sex life is improved because the worry about contraception is removed Despite the absence of sperm in the semen, the fluid ejaculated seems normal because most of it is produced high in the tubes at the base of the penis Normal sexual activity can be started to days after vasectomy, but it is important to continue some form of birth control until the sperm count is zero How is the operation done? This simple operation, which can be performed under a local or a general anaesthetic, usually takes about 30 minutes It is done through two small cuts in each side of the scrotum (bag) or through one cut in the middle The ‘vas’ tube, which lies just below the skin, is picked up and cut About cm of it is removed; the ends are tied off and then cauterised with a hot needle How effective is a vasectomy? Vasectomy is reliable because every precaution is taken to separate the tubes so that they not rejoin Despite this, about in 500 vasectomies fail because the tubes somehow manage to rejoin Is the man sterile immediately? No It takes about 20 ejaculations to clear all the sperm from the tubes above the cut About to months after the operation it is necessary to have or (preferably 2) sperm counts to make sure that the semen has no sperm The semen has to be collected by masturbation and examined under a microscope What happens to the sperm? Sperm are still produced in the testicles but lie around in the blocked tube for about weeks before shrivelling up and being absorbed into the body in a similar way to blood after a bruise Sperm make up only about 1% of the fluid ejaculated What are the side effects of vasectomy? Bruising and swelling are common problems but settle after about days Bleeding and infection occur sometimes, but they settle quickly with treatment A small lump caused by a build-up of sperm can develop at the operation site: these sperm granulomas usually settle themselves Can vasectomy be reversed? The cut tubes can be rejoined by microsurgery, but there is no guarantee of regaining fertility As a general rule about 40% of vasectomy reversals lead to successful pregnancy Vasectomy should be regarded as permanent and irreversible It is important to be definite about the decision to have the operation and not to have it under pressure tube (vas deferens) cut and tied on both sides so that sperm are blocked from entering the semen blocked sperm testicle MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 107 Arthritis in the elderly Arthritis means inflamed joints, and there are many types of arthritis The most common type is osteoarthritis, which is a problem of wear and tear due to excessive use over the years and to old injuries in the affected joints Most cases of arthritis are mild, and people cope with it Arthritis does not necessarily get worse as you get older; sometimes it can get less painful (arthritis in the lumbar spine is a good example of this) What are the symptoms of osteoarthritis? • Pain, swelling or stiffness in one or more joints • Pain or stiffness in the back or neck • Pain and stiffness after heavy activity such as gardening or housework or long walks and on getting up in the mornings; light activity might actually relieve some of the symptoms • Painful limp in the case of the hip and knee Which joints are affected? Osteoarthritis mostly affects the weight-bearing joints such as the spine, knees and hips The base of the thumb, the ends of the fingers and the big toes are also common sites What is the treatment? There is no cure, but there are many ways to make life more comfortable and keep you mobile and independent Diet Keep your weight down to avoid unnecessary wear on the joints No particular diet has been proved to cause, or improve, osteoarthritis so inform your doctor if you have had a peptic ulcer or get indigestion There are new drugs that are kinder to your stomach Some people find over-the-counter remedies such as glucosamine can help bring relief Consult your doctor to find the right medication for you Special equipment It is possible to increase your independence at home. There is a wide range of inexpensive equipment and tools that can help with cooking, cleaning and other household chores These can be discussed with your physiotherapist or occupational therapist Surgery Modern surgery can give excellent results with relief of severe pain for most joints The new techniques and artificial joints are improving all the time, and so there is no need to suffer with prolonged severe pain Osteoarthritis of the hip Replacement of your worn-out joint with an artificial hip made of a combination of metal or plastic is a very common operation More than 90% of these are most successful new plastic socket metal hip replacement Exercise Keep a good balance of adequate rest with sensible exercise (such as walking, cycling and swimming), but stop any exercise or activity that increases the pain Heat It is usual to feel more comfortable when the weather is warm A hot-water bottle, warm bath or electric blanket can soothe the pain and stiffness Avoid getting too cold bone Physiotherapy This can be most helpful in improving muscle tone, reducing stiffness and keeping you mobile 108 Walking aids Shoe inserts, good footwear and a walking stick can help painful knees, hips and feet Total hip joint replacement Medication Paracetamol can be an effective painkiller in mild cases If pain continues, doctors may recommend a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen They should be taken with food These drugs may have side effects in the stomach or intestine, Corticosteroids or lubricating fluids for the knee can be injected directly into the knee and can provide temporary relief Modern knee replacements are also giving excellent results, and if you have crippling knee pain this operation can give great relief MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL Osteoarthritis of the knee Dementia What is dementia? How is it diagnosed? Dementia is a disorder in which a previously normal brain does not function normally and the affected person becomes confused, forgetful and out of touch with the real world It is rare in people under 65 years of age and appears more likely to develop with increasing age It tends to progress slowly after it develops So early signs are subtle and vague, and dementia may take some time to be obvious The cause is not always known, but dementia can follow brain damage from physical abuse such as boxing, excessive alcohol and other drugs, and hardening of the arteries to the brain There is a genetic tendency to early dementia in some families A correct diagnosis is very important GPs are often the first to diagnose it by doing a mental state examination on a person and then, if they suspect dementia, referring the person to a specialist or specialist clinic such as a Cognitive, Dementia and Memory Service clinic for evaluation and further tests What is Alzheimer’s disease? How common is dementia? The older a person gets, the more likely they are to have dementia The incidence is probably about person in 10 over 65 years, 1 in over 80 years and in 10 at 100 years What are the risks? This refers to the most common type of dementia in which there is wasting of some brain cells, the cause of which is uncertain It can occur at any age, but when it develops at a relatively young age (under 65) it is referred to as presenile dementia It is sometimes familial (inherited), although anyone can develop Alzheimer’s disease It is more common in people who have some other condition such as Parkinson’s disease or Down syndrome Another common type of dementia is vascular dementia, which is caused by multiple ‘mini-strokes’ caused by disease of the small arteries in the ageing brain A person with dementia is always at risk of accidents in the home involving fire, gas, kitchen knives and hot water Accidents at the toilet, in the bath and when crossing roads may be a problem, especially if dementia is combined with failing sight and hearing These people should not drive motor vehicles Without proper supervision people with advanced dementia are likely to eat poorly, neglect their bodies and develop medical problems such as skin ulcers and infections They can also suffer from malnutrition and incontinence of urine or faeces What are the symptoms? What is the treatment? There are 10 key features or warning signs: The main feature is loss of memory of things that have happened recently.You will notice that the person cannot remember what has happened a few hours (or even moments) earlier but can clearly remember events in the past Apathy and loss of initiative Misplacing things Problems with language (e.g finding the right word) Difficulty performing familiar tasks Disorientation in time and place Poor or decreased judgement (e.g driving) Problems with abstract thinking (e.g balancing a cheque book) Personality changes, such as being suspicious, irritable, humourless, uncooperative or aggressive, overfamiliar 10 Changes in mood and behaviour (e.g rapid mood swings, withdrawn, confusion, restless) The problem occasionally results in marked emotional and physical instability It is sad and difficult for relatives to watch their loved ones develop aggressive and antisocial behaviour, such as poor table manners, poor personal cleanliness, rudeness and a lack of interest in others Sometimes severe problems such as violent behaviour, sexual promiscuity and incontinence will eventuate If you suspect that a friend or relative has early dementia, take him or her to the doctor for assessment If they will not cooperate, contact an aged care assessment team There is no cure, but some modern drugs may improve the symptoms in some people for a limited time—in the order of to 12 months Ask your doctor about this However, the best that can be offered is tender, loving care Regular home visits by caring, sympathetic people are important Such people include relatives, friends, general practitioners, district nurses, home help, ministers of religion and Meals-on-Wheels People with dementia tend to manage much better in the familiar surroundings of their own home Special attention should be paid to organising memory aids such as lists, routines and medication, and to hygiene, diet and warmth Adequate nutrition, including vitamin supplements if necessary, has been shown to help these people Support groups It is important to contact an Alzheimer’s support group in your state or locality One such special support and advisory group is called ADARDS (the Alzheimer’s Disease and Related Disorders Society) MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 109 Eye problems in older people Many older people have no problems at all with their eyes and vision, with most maintaining good eyesight into their eighties However, natural physical changes can cause some problems with age, and disorders such as cataracts and glaucoma are more likely to occur Older people generally need brighter light for everyday tasks such as reading, cooking, mending and driving a car Common eye complaints Presbyopia This is a common disorder first noticed after the age of 40 (usually 45 years onwards) when a change in the eye muscles and lens caused by loss of elasticity makes reading more difficult You can read only by holding the material at arm’s length This applies to small print such as in telephone books and street directories It is a focusing problem, which is easily corrected by having reading glasses with a convex lens Every few years you will need slightly stronger spectacles to allow for decreasing ability to focus Bifocal lenses may be needed if you have another eye problem 110 Dry eyes This is caused by a reduced production of tears by the tear glands It can cause many problems, such as blurred vision, itching or burning It is easily corrected by using artificial tears Common eye diseases Glaucoma Glaucoma is caused by too much fluid pressure in the eye, which can lead to blindness It comes in two forms: the rarer acute form (which causes sudden pain and visual problems) and the common chronic form (which slowly develops without any early symptoms) It is important to have any unusual eye symptoms checked, and all elderly people should have eye tests (including eyeball pressure) every to years When detected, it can be treated and blindness prevented Cataracts Normally the lens within the eye is clear and allows light to pass through it A cataract is where the clear lens becomes cloudy or opaque and cuts down the light entering the back of the eye Apart from deterioration of vision, there are no other symptoms Cataracts can occur in anyone but are more common in diabetics and those taking cortisone as tablets or by inhalation Cataracts can also run in families They are diagnosed during an eye examination A modern lens implant (an artificial lens placed in the space left by the cataract lens) can give excellent results Macular degeneration The macule is a vital area of the retina near the optic nerve that is responsible for the fine detail of sight in the central field of vision Degeneration of the macule is a feature of older people, and is caused by a faulty blood supply It comes on gradually and is painless If your central vision appears blurred or fuzzy and sharp vision is affected, you should report the problem immediately Floaters A common complaint is of seeing tiny spots or specks that float across the eye, especially in bright light They are normal and usually harmless but may be a warning of impending eye problems If they become more noticeable or cause flashes of light, report to your doctor Retinal disorders Disorders of the retina (the photosensitive area of the eye) can lead to varying degrees of blindness Diabetes and other diseases can cause retinal problems Sometimes the retina can become detached and seriously affect your eyesight Retinal detachment can be treated successfully if detected early Excessive tears Excessive tears are usually a sign of increased sensitivity of the eyes to wind, light or temperature changes This complaint is very common in a cold wind It can be minimised by wearing glasses, especially sunglasses, in those conditions However, it may indicate blocked tear ducts (lacrimal ducts) or an eye infection, and so an eye check is recommended Tips • Light bulbs are better than fluorescent lights • Have regular checks for blood pressure and diabetes • Have an eye examination every to years • Eye problems tend to run in families MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL Falls in older people The problem of falls in older people What should be done to prevent falls? Falls are the most common accidents in older people and most serious in people over 65 years as our reflexes deteriorate with age It is a particular problem in people with brittle bones—osteoporosis About 5% of falls result in a fracture Medication Be aware that taking medicines can put you at risk because many can make you giddy and reduce your alertness This effect is aggravated by taking alcohol Discuss the effect of medication with your doctor and pharmacist How common is the problem? About 30% of people over the age of 65 experience at least one fall per year, with in of these having a significant injury More falls occur in the evening and at night, due to decreased light and tiredness Common causes of falls General physical factors • Increasing age • Poor physical function • Eyesight—impaired vision • Impaired lower limb strength • Impaired balance and walking • Low morale/depression • Drug usage especially sedatives • Poorly supporting footwear Medical conditions • Medication • Cardiovascular disease • Low blood pressure • Stroke • Eyesight disorders (e.g cataracts) • Poorly controlled diabetes and epilepsy • Arthritis/foot disorders • Parkinson’s disease • Balance disorders (e.g Ménière’s syndrome) • Psychological conditions • Dementia or delirium Hazards in the home • Slippery surfaces (e.g wet floors, shower, bath) • Loose mats • Uneven paving or pathways • No handrails on stairs • Poor lighting • Loose objects on floor (e.g children’s toys) Physical strategies Falls can be prevented by the following rules, irrespective of age: • Walking aids If you are unsteady on your feet (even slightly) use a single-point stick or a walking frame • Footwear Wear good-fitting shoes or slippers with non-slip soles; avoid long or loose shoelaces • Eyesight If you require glasses, make sure you wear them Don’t walk around with reading glasses, especially on stairs (take them off when moving around) • Good lighting indoors Avoid wandering around in the dark Make sure you have a bedside lamp or night light in the bedroom for getting out of bed at night Also have a good torch by the bedside • Good lighting outdoors Make sure that steps and stairs are brightly lit White paint or flush metal edges on the corners of the steps are useful • Supportive railings Install strong railings along all indoor and outdoor steps • The bathroom Fit secure handrails in easy reach near the bath, shower and toilet Use non-slip mats alongside and inside the bath or showers Use liquid soap in preference to soap bars • Climbing Avoid standing on chairs, stools or ladders to reach things Store clothes and frequently used items within comfortable reach • Loose mats Ensure that carpets and other floor coverings are secure around the edges Avoid loose mats or rugs, especially on shiny, polished floors • Loose wires and cords Do not allow wires or cords from electrical appliances to be exposed or run loosely along the floor • Clutter Make sure rooms are kept as clutter-free as possible, especially where older people move around Children’s toys are a particular hazard Be particularly careful of pets especially dogs in the house (and also outside) What are the risks? Physiotherapists and occupational therapists Risks include fractures, especially of the femur or spine, head injuries, particularly falling against something sharp and dangerous, and burns against a heating appliance or boiling water These therapists can provide valuable advice about aids and safety in the home Physiotherapists can assess and improve balance skills, flexibility and activity of people, including those with disorders such as Parkinson’s disease MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 111 Hearing impairment in older people Loss of hearing tends to gradually increase with advancing age Every year after the age of 50 we lose some of our hearing ability As many as 25% of people aged 60 to 70 report hearing impairment The decline varies from person to person and, like greying of hair, occurs at different rates What are the symptoms? The symptoms vary, so that some barely notice a problem while others are severely disabled Common symptoms include: • inability to hear speech and other sounds loudly enough • inability to hear speech and music clearly, even when it is loud enough • inability to understand speech, even when it is loud enough (a problem of language reception) People with mild hearing loss notice only subtle differences and may have trouble hearing certain high frequency sounds such as s, f or th They may also have trouble hearing in certain situations, such as at a party or in a crowd where there is a lot of background noise Those with moderate hearing loss have trouble hearing in many situations In very old people, deafness can lead to unexpected behavioural problems such as confusion, agitation, anxiety, depression and paranoid delusions What are the causes? Hearing loss takes two forms: conduction loss, where the sound waves are blocked in their passage to the inner ear, and neurosensory loss, where the inner ear cannot pick up the sound waves properly and thus transmit them to the brain Causes of conductive deafness (usually reversible) • Too much wax in the ears • Other debris in the ear canal (e.g cotton bud tip) • Ear infection • Faulty vibrating bones (otosclerosis) Causes of neurosensory deafness (usually not reversible) • Nerve damage • Exposure to loud noise, including sudden explosions • Certain drugs 112 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION â MCGRAW-HILL Brain tumours Presbycusis What is presbycusis? Presbycusis (pronounced ‘prez-bee-ku-siss’) is also known as ‘old age’ deafness and is the most common type of hearing impairment in older people It is caused by wear and tear in the very delicate workings of the inner ear It does not cause total deafness but difficulties in understanding speech, especially with background noise What are some features of presbycusis? • • • • • Inability to hear high-frequency sounds Usually an association with tinnitus (ringing in ears) A genetic tendency to the problem Intolerance of very loud sounds Difficulty picking up high-frequency consonants (e.g f, s), which are often distorted or unheard People with presbycusis frequently confuse words such as fit and sit, math and mass, fun and sun They often say ‘Don’t shout—I’m not deaf’ What signs indicate that hearing should be tested? • Speaking too loudly • Difficulty understanding speech • Social withdrawal • Lack of interest in attending parties and other functions • Complaints about people mumbling • Requests to have speech repeated • Complaints of tinnitus • Setting television and radio on high volume Patients are usually referred to an audiologist after a medical check What can be done? If medical problems such as fluid or wax in the ear are not present and ‘old age’ deafness is proved on testing, a hearing aid is usually fitted There is no cure for the problem and hearing aids are not the perfect answer However, modern hearing aids can be tailor-made for the individual person and are usually quite effective Leg ulcers What are leg ulcers? Leg ulcers are abnormal ‘holes’ that occur in breaks in the skin in the lower leg Ulcers can occur in any person, but the elderly who have poor circulation are most likely to develop ulcers They usually occur in the area known as the gaiter area of the leg Twice as many women as men are affected typical site of ulcer area prone to ulcers (gaiter area) for long periods, but undertake moderate walking exercise Avoid smoking and have a nutritious diet Be extremely careful not to injure the leg, as the skin of the legs is fragile Do not scratch, watch out for sharp stakes in the garden and be careful of hot-water bottles Keep ulcers covered and sterile (ulcers require moisture to heal) Medical help The ulcer will require regular dressings to keep it clean and free from infection Special substances may be added to clean out the debris in the ulcer A nurse may be able to call regularly to dress the ulcer It is usually better to keep the dressing on for a few days You will be provided with a knee-high elastic bandage or a thick elastic stocking to wear during the day It may be necessary to apply a skin graft to promote the healing What is the cause? Ulcers are usually caused by a combination of two problems: rather sluggish circulation to the leg and poor drainage due to varicose veins The further the distance is from the pump (the heart), the more likely the area is to be affected by poor circulation, so that the ankle area is the most vulnerable The skin becomes thin, and because injuries such as those from knocks or scratches are common here the skin tends to break down and heal poorly The small crack in the skin may enlarge and gradually become an ulcer What are the symptoms? An elastic bandage helps healing The ulcer has dead tissue in it and usually weeps The most common site is the skin on the inside of the leg just above the ankle The skin around the ulcer usually becomes red, itchy, flaky and discoloured Many are not painful, just uncomfortable, but those due to very poor circulation can be quite painful, especially if on the foot What are the problems? Slow healing is the main problem This is usually not a serious problem, but an ulcer can take months or years to heal in an older person Ulcers in younger persons usually heal in a few weeks Those with diabetes or peripheral vascular disease (clogged arteries) heal slowly Rarely, the ulcer is due to an infection or can develop into skin cancer and therefore needs careful medical attention What is the treatment? Self-help The key to healing is to keep the leg elevated as much as possible and also to keep fluid out of the leg, which is helped by a firm bandage Raising the legs above the level of the heart reduces swelling and quickens healing Avoid standing Rest and elevate the legs as much as possible Remember • Keep your leg elevated as often as possible • Keep the leg compressed with a firm bandage, tights or support stockings • Avoid further knocks and other injury MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 113 Osteoporosis What is osteoporosis? Osteoporosis, which means ‘bones with holes’, is a condition leading to thinning of bones so that they become weak and brittle due to loss of calcium may give some idea but they are limited because osteoporosis is not detectable until up to 50% of bone is lost The best test, which is done on the spine and neck of the femur bone, is the DEXA bone densitometry scan What can you about it? osteoporosis thinner bone normal thicker bone Who gets it? Osteoporosis is found mainly in middle-aged and elderly women, after the menopause (when the periods cease) It can also affect men Why they get it? Women at greatest risk are those who: • are of Caucasian or Asian racial origin • have a family history of osteoporosis • are thin and slight • smoke cigarettes • drink alcohol • drink a lot of caffeine drinks (e.g more than cups of coffee a day) • get little exercise or physical activity • have little calcium in their diet • have low vitamin D levels from lack of exposure to the sun • have a poor diet in general • lack hormones due to the menopause, especially early menopause • have taken cortisone tablets over long periods The longer you live, the greater the chance you have of getting osteoporosis What is the risk? The main risk is a bone fracture, especially of the hip, spine or wrist from a fall Sometimes a bone will collapse or break without injury (e.g coughing causing a fractured rib) Osteoporotic fractures of the spine can cause gradual development of the ‘dowager’s hump’, an abnormal outward curvature of the upper spine in the back How you know if you have it? Most women not know, because thinning of the bones occurs unobtrusively It is often first noticed when a bone breaks, usually the hip, wrist or vertebrae of the spine X-rays 114 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL • Take regular weight-bearing exercise such as dancing, tennis, jogging and walking (e.g brisk walking for 30 minutes times a week) • Stop smoking • Cut down on alcohol and caffeine • Have a healthy diet • Have adequate calcium in your diet: 1000 to 1500 mg per day (1500 mg if postmenopausal) Eat calcium-rich foods such as low-fat calcium-enriched milk (500 mL contains 1000 mg), other low-fat dairy products (e.g yoghurt or cheese), fish (including tinned fish such as sardines and salmon, with the bones), citrus fruits, sesame and sunflower seeds, almonds, brazil nuts, hazelnuts and tofu • Use vitamin D—best got from sunlight on your skin (face and arms) (e.g 20 minutes exposure a day according to where you live and the seasons) However, avoid exposure to the sun during peak hours (10am–3pm) in summer, which may increase the risk of skin cancer Drug treatment At one time, doctors recommended preventive hormone replacement therapy with oestrogen following the onset of the menopause but this is no longer recommended, due to side effects However, there are now many other drugs available to improve established osteoporosis These include: • bisphosphonates • selective oestrogen receptor modulators (SERMs) • strontium ranelate • tibolone • calcitriol (a vitamin D derivative) What can your doctor do? Your doctor may: • discuss your diet • suggest calcium supplements • review your ‘risks’ for osteoporosis, and if you are at high risk suggest further tests such as bone density measurement • prescribe special medication Key points • Osteoporosis is a common condition • It starts from a young age but develops faster in middle and older age • The main aim is to prevent it from occurring, including preventing falls Parkinson’s disease What is Parkinson’s disease? What causes the symptoms? Also known as shaking palsy or paralysis agitans, Parkinson’s disease is due to an imbalance of chemicals in the nerve cells in the brain that regulate movement Because these cells not ‘fire’ smoothly, various body movements are affected The problem is caused by the lack of a special chemical in the brain called dopamine, which the nerve cells need to ‘fire’ It is rather like the chemical in a battery gradually running out so that the battery becomes flat It is not caused by a brain tumour or a stroke, but in some cases poor circulation to that part of the brain can be responsible for the problem How common is the problem? About person in 1000 develops Parkinson’s disease, and these are mainly elderly or in late middle age The exact cause is unknown It can be caused by some drugs and toxic fumes or substances such as carbon monoxide and lead There is a hereditary tendency to the disease What are the symptoms? The symptoms are: • stiff, rigid and slow movements, causing difficulty starting a movement • a shuffled walk • an expressionless face • slow and flat speech • difficulty writing (small handwriting) • instability of posture—prone to falls • a tremor, especially on the hands and arms, with a rubbing together of the thumb and forefinger; the tremor is worse at rest and tends to go away when an action such as picking up a pen or other object is performed There is no pain, numbness or pins and needles Later on falls may be a problem expressionless face slow, flat speech stooped posture What are the risks? The disease is not life-threatening because it does not affect nerves that supply the heart or other vital organs, but two common risks are falls and mental depression What is the treatment? Self-help An important part of managing at home is to keep as active as possible with the help of a caring family, friends and other people.Your mobility can be assisted, for example with walking sticks, bath-rail supports, special banisters where you normally walk, and chairs with high seats and arms It is important to have regular exercise and to stick to your everyday routine as actively as possible Your doctor should see you regularly to assess your progress Ask about special programs to teach people how to improve their balance and coordination Medication No drug will cure the problem, but there are modern drugs that can much to relieve symptoms, particularly stiffness and poor mobility Drugs that lead to higher levels of dopamine in the brain can be prescribed and it is better to begin them early rather than wait until the symptoms are more severe The drugs can have side effects such as feeling sick in the stomach (nausea) and a dry mouth, and so your doctor will have to juggle them according to the progress you are making What is the outlook? tremor of hands at rest There are many different grades of severity, but many people have a mild problem and are able to cope, even without the need for dopamine-producing drugs If the disease gets worse, it is usually only a very slow process; it is rare that a person gets severely disabled and confined to a wheelchair If you develop Parkinson’s disease after the age of 60, you may expect to live out your normal life expectancy stiff and slow movements shuffled walk Symptoms of Parkinson’s disease MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 115 Retirement planning Retirement can be a most enjoyable period of the life cycle, one of productivity and self-realisation However, for many people it can bring considerable unforeseen sadness and stress This is mainly brought about by inadequate planning and changes of relationships A person’s work in most cases is a means of providing a sense of purpose, personal fulfilment and mateship Studies show that very few people plan for retirement until just before the time Planning your after-work lifestyle It is important to think this through and perhaps plan a combination of rest and recreation, travel and activity It is worth considering that the average person can expect to live to a certain age—currently 84 for women and 79 for men You should plan with at least this life expectancy in mind What are the main problems? Common problems in retirement are: • loneliness • boredom • financial worries country people who move to the city You need your family around you, especially if your spouse dies You should give consideration to keeping your family home, because it encourages your family to visit you Children often interpret a move to a small unit as ‘don’t come and stay with us’, although this may not be the intention Financial security You really need sound advice for a secure financial future, including investments Try to work out your finances years in advance and allow for inflation and home maintenance If you own your home and car, you have a good basis You should consider your means of paying for your future health services including health insurance if necessary Health You need good health to enjoy your deserved retirement Take care not to get into bad eating and exercise habits Plan a sensible, healthy, balanced diet Avoid smoking and excessive drinking Regular and effective exercise is important Appropriate exercises are walking for 20 to 30 minutes each day, swimming, cycling and golf Activities Retirement gives you the opportunity to devote more time to those interests and hobbies that you already enjoy It will also give you the chance to pursue new ones There are many agencies that will provide information on programs for the retired, adult education courses (especially in the arts and crafts) and community work If your hobby can supplement your income, that is a bonus Useful activities include sports such as bowls, golf and tennis, travel, nature walking and voluntary or part-time work Many retired people get considerable pleasure out of carpentry and woodwork Housing Keep your family home if you can Carefully weigh up the pros and cons of moving—it can bring much stress, worry and financial problems As you get older it is most important to have transport, shopping and medical facilities nearby Loneliness Loneliness is a terrible problem; it can lead to depression and a feeling of worthlessness A common mistake is to sell the family home and move to another location, usually in a small unit This separation from old friends, neighbours and family can cause much heartache It often happens to 116 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL Companionship Good friends and neighbours are excellent ‘insurance policies’ for a happy retirement Try to keep in contact with your valued friends The relationship between husband and wife will be tested, as you have to spend much more time together Sadly some couples cannot cope with this ‘under my heels’ syndrome and marital breakdowns occur Make sure this does not happen to you Stroke What is a stroke? area of brain affected A stroke, also called a cerebrovascular accident (CVA) or ‘brain attack’, occurs when an area of the brain is damaged following interruption to its blood supply This results in deterioration of the mental and physical functions controlled by that particular area of the brain nerves to skin and muscles What is the cause? There are three main causes: • thrombosis: a clot forming in the artery to the area • embolus: a small clot from elsewhere blocking the artery • haemorrhage: bleeding into the brain (unlike the others, where the artery is blocked) The risk factors for stroke are: • high blood pressure • high cholesterol • diabetes • smoking • heart disease • abnormal rhythms of the heart such as atrial fibrillation (AF) An accident to one side of the brain will lead to paralysis of the opposite side of the body What are the symptoms? How can strokes be prevented? The symptoms depend on the area of the brain affected and the cause A haemorrhage usually has a sudden onset and a less favourable outlook Sometimes a stroke is mild and the effects pass off in a day or so Symptoms include: • unconsciousness • confusion • loss of power of speech • loss of movement of part of the body (e.g on one side of the body) • double or blurred vision • difficulty understanding questions • headache • dizziness • difficulty walking or using arms • numbness or a weak feeling on one side of the body (face, arm or leg) The risk factors need to be checked, especially high blood pressure and cholesterol, which must be kept under control Other things to are avoid smoking, avoid excessive alcohol intake, eat a low-fat healthy diet, keep to an ideal weight and have regular exercise If you have been found to have hardening of the arteries to the brain, you may be advised to have tablets to prevent blood clots (thrombosis) forming Aspirin can this, and only a small dose is needed Special blood-thinning tablets called anticoagulants (commonly warfarin) can be prescribed to help prevent clots What is a transient ischaemic attack? This is a transient loss of function due to a temporary blockage in the artery It is usually caused by a small embolus and the person recovers in a period ranging from a few minutes to 24 hours (average time minutes) It can be a warning of an impending stroke, and so it needs urgent medical attention How common are strokes? They are very common, especially in people over 65 years and more so in males In Western countries they are the third most common cause of death and after heart attacks the second most common cause of sudden death Those at special risk are those with high blood pressure, diabetes or high blood cholesterol and heavy smokers, and those with abnormal heart rhythms such as atrial fibrillation (AF) Surgery If a person has partially clogged arteries to the brain (the carotids), it may be possible to clean them out, rather like a brush cleaning out a chimney This operation is called a carotid endarterectomy and is a good option in some patients, especially in those who have had transient ischaemic attacks What is the treatment? It is important to call an ambulance and get to a stroke unit in a hospital as soon as possible To tell whether a person has had a stroke, follow the FAST rule: • F: facial weakness (ask the person to smile) • A: move arms (raise both arms) • S: speech (speak a simple sentence) • T: time—act quickly and call and ambulance if the person has trouble with any or all of the above The sooner a person with a stroke gets to hospital, the better the outcome If a person has a stroke caused by a blood clot, and gets to hospital within hours, doctors may give an injection to dissolve the blood clot Once a person has stabilised and is recovering, intense rehabilitation to get limbs and speech working again is important Ideally physiotherapy should be commenced in the first days MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL 117 Tinnitus What is tinnitus? What are its effects? Tinnitus is hearing abnormal noise in the ear or head when there is no sound coming from the outside The word tinnitus comes from the Latin tinnire, which means ‘to ring’ Although it usually refers to ringing in the ear, tinnitus may include buzzing, roaring, whistling, knocking, hissing, humming or a combination of sounds The main problem is the psychological effect, as the noise tends to affect one’s concentration, ability to think and peace of mind Stress can aggravate the problem It can also be a problem at night, when it is more noticeable and affects the ability to sleep outer ear semicircular canals ear canal to brain ear drum middle ear How common is tinnitus? Although most of us experience tinnitus at some time, especially with a lot of wax blocking an ear, it is only a temporary problem About in people are bothered by it, but it is a severe problem for 2% of the population What causes or aggravates it? • • • • • • • • • • Ear disorders such as infection Excessive noise exposure for a long time Wear and tear of the ear with ageing Some prescribed drugs Stress and fatigue Excessive alcohol Heavy smoking Social drugs, including caffeine and marijuana Head injury Ménière’s syndrome (fluid in the inner ear) How serious is tinnitus? Tinnitus in itself is not a serious condition; it does not cause pain or deafness but can be frustrating Most people with tinnitus have a hearing loss, but there are also many people with normal hearing who have tinnitus Many people with tinnitus worry that it is a symptom of a brain tumour, a stroke, a nervous disorder or some other serious head problem However, this is rarely the case 118 MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL What can be done for tinnitus? Tinnitus is less noticeable when there is background noise, and therefore it is important to ‘switch off’ from the ear ringing as much as possible and focus on other noise The following methods can help one cope with tinnitus Stress management and relaxation techniques Since tinnitus is more noticeable when you are stressed, tired or emotionally upset, learning relaxation or meditation techniques to focus your attention elsewhere may be helpful Some patients are helped by hypnosis.Your doctor will advise on these methods Background sound treatment A useful treatment, especially for those having trouble getting to sleep, is to have background music playing when retiring at night Other sounds that are sometimes used include FM static produced by a radio set off the station and environmental sound-masking tapes Tinnitus maskers Some people are helped by wearing a tinnitus masker, which is a device like a hearing aid worn behind the ear It produces a type of hissing noise that tends to counter-balance the tinnitus noise Hearing aids If a hearing loss accompanies the tinnitus, the use of a hearing aid can mask the tinnitus with amplified sound This makes it easier to focus on outside sound Distracting activities Some people can cope by diverting their attention away from their tinnitus by keeping themselves busy and undertaking interesting activities that focus their mind elsewhere Examples include gardening, power walking, music, television, handicrafts, jigsaw puzzles, card playing and discussion groups Counselling and support Most cities have a counselling service for tinnitus sufferers Ask your doctor about the Australian Tinnitus Association ... 11 1 Hearing impairment in older people 11 2 Leg ulcers 11 3 Osteoporosis 11 4 Parkinson’s disease 11 5 Retirement planning 11 6 Stroke 11 7... 11 8 Part General health 11 9 8 Prevention Cardiovascular (including coronary) risk factors 12 0 Cholesterol: how to lower cholesterol 12 1 Diet guidelines for good health 12 2... 16 1 Worms 16 2 10 Eye disorders Blepharitis 16 3 Bloodshot eye 16 4 Cataracts 16 5 Chalazion (meibomian cyst) 16 6 Colour blindness 16 7