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Context Final > Aging/Primary Care/VA > Flashcards

Aging/Primary Care/VA Flashcards

1
Q

Aging

A
  • Sue has 8 slides, and there is no information on them

- normative aging does not equal diseases that increase with aging

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2
Q

Primary Care: Levels of Prevention

A
  • Primary: Prevent before it occurs
  • Secondary: Early detection and treatment to reduce the impact
  • Tertiary: Reduce impairments and lessen impact of ongoing illness or
    injury
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3
Q

OT in Primary Care

A
  • interprofessional team
  • address a large majority of personal health care needs
  • client centered
  • long term relationships with clients
  • chronic disease management
  • context of community
  • across the lifespan
  • patient care coordination
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4
Q

PACE stands for

A

Program for All-Inclusive Care for the Elderly

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5
Q

PACE

A
  • Focus on Frail, Disabled Complex Elderly
  • Comprehensive
  • Integrated
  • Community-Based
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6
Q

PACE Eligibility

A
  • Age 55+
  • Nursing home certified
  • PACE service area
  • able to live safely in the community
  • must enroll all eligible participants
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7
Q

PACE Enrollees

A
  • Mean Age: 80
  • 75% Women
  • Average # Basic ADL Deficits: 3.5
  • 63% Have Cognitive Impairment
  • Average Life Expectancy: 4.5 years
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8
Q

Traditional Model (T) vs PACE Model (P)

  1. Overarching Theme
  2. Care
  3. Financing
A
  1. T: Fragmentation. P: Integration
  2. Care - T: multiple providers, discontinuity across sites. P: outpatient care, acute care, long term care
  3. Finances - T: multiple payers, institutional bias, restrictions. P: all-inclusive, full risk, no restrictions
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9
Q

PACE - Role of OT

A
  • PACE Centers
  • OT evaluation
  • 6 month check-ins
  • Home visits (Home, Assisted Living Facilities, Skilled Nursing Facilities, Nursing Homes)
  • Education (Family/Caregiver/Home Health Aide/ Personal Care Worker)
  • Adaptive Equipment/ Durable Medical Equipment
  • Coordination for driving assessments
  • Low Vision (MA Commission for the Blind, Perkins School)
  • Annual trainings of Home Health Aides for transfers, body mechanics, falls and feeding
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10
Q

PACE Supportive Housing

A
  • PACE partnered with Boston Housing Authority (BHA) to create 12 apartments
  • Residents must have BHA housing and be enrolled in the PACE program
  • Participants must agree to attend the PACE center daily.
  • Eligibility is discussed on a case to case basis for who is appropriate
  • There is a staff member seven days a week for overnight care.
  • One apartment is now available for short term respite stay for PACE participants in need
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11
Q

The Boston Surge

A
  • Mayor Marty Walsh’s initiative to end chronic homelessness in Boston
  • Boston has held five events in 2016 pairing 50 homeless veterans with housing and services from the VA
  • The City compiles a list of chronic homeless individuals they want to place in housing aged 55+
  • Along with receiving an apartment the “guests” are also enrolled in PACE or a similar community healthcare program
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12
Q

PACE Case Study:

  • Participant: 89 year old Spanish speaking female. PMH includes osteoarthritis, back pain, right shoulder pain, urinary incontinence, hypertension, vascular dementia, low vision, and hard of hearing. Participant was wheelchair bound and home bound.
  • Location: Was living in an apartment in the community with her husband until he died unexpectedly.
  • PACE: Provided home delivered meals, home health aides 2x daily, medications, initiated bed bug management, daily center visits for socialization, and transferred her into supportive housing.
A
  • Progression of OT role: Assessment for needs of the role of personal care and IADL assist. Recommendation for a hha 2x daily, assist with weekly laundry and weekly homemaking, daily exercise program, and provided full DME set up for the bathroom. Also worked to get her audio tapes from the Perkin’s School and a large button phone due to hard of hearing and low vision.
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13
Q

Agent Orange

A
  • Vietnam War
  • Aerially sprayed herbicide to remove foliage as cover for the enemy
  • Exposed veterans are now sick, need OT
  • Conditions Related to Exposure:
    AL Amyloidosis, Diabetes Mellitus II, Hodgin’s Disease, Ischemic Heart Disease, Parkinson’s Disease, Multiple Myeloma, Chloracne
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14
Q

Veterans Access Choice and Accountability Act of 2014

A
  • Geographical Burden (40 miles)
  • – veterans may have to travel far to see OT - not a good plan for people who have cognitive/physical health problems
  • Wait longer than 30 days
  • – also not good for your health
  • Service not offered by a VA Medical Center
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15
Q

VA: Psychosocial Considerations

A
  • PTSD
  • – OTs Provide Screening: Primary Care PTSD Screen (PC-PTSD)
  • Depression
  • – OTs Provide Screening: PHQ-9
  • Mild Traumatic Brain Injury
  • Military Culture
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16
Q

Mild Traumatic Brain Injury

A
  • IEDs are largest cause of combat-related TBIs
  • Cause “Blast Injury,” more diffuse than a typical TBI
  • “Trademark” injury of The Global War on Terror
  • Symptoms often overlap with those of depression, anxiety, or PTSD
17
Q

Military Culture

A
  • Team over individual
  • Warrior Image
  • To need help is to be weak
18
Q

VA Case Study: Which cognitive assessment would you use to assess Mr. Joseph’s ability to calculate and understand his insulin needs? Consider availability of assessment, administration time, and the client’s compliance.

A
  • MET: have calculating insulin as one of the errands
  • Something with problem solving?
  • Can I just ask him to explain the procedure to me?
19
Q

VA Case Study: Mr. Joseph reports that he has trouble sleeping at night and therefore gets tired and foggy throughout the day. He thinks this is part of why he cannot remember to check his blood sugars throughout the day. What other clarifying questions might you ask?

A
  • ask about sleep hygiene and more details about his sleep problems
  • ask if he has days he sleeps well, and how he does with checking his blood sugar
  • ask about diet and exercise as well
20
Q

VA Case Study: Mr. Joseph becomes defensive and irritable after you suggest that he has cognitive deficits that may be affecting his ability to control his blood sugars. He tells you that he has fought for his country and does not deserve to be treated like a child. What strategies might you use to help de-escalate the situation and proceed with the session?

A
  • Emphasize that you do not mean to treat him like a child, that it is common for veterans to have cognitive deficits, and that it in no way means that he is not intelligent or minimizes his service or the respect he deserves
  • apologize
21
Q

VA Case Study: Mr. Joseph’s cognitive assessment has demonstrated that Mr. Joseph has memory deficits and that he does better with written information compared to verbal information. What strategies might you suggest to increase Mr. Joseph’s medication compliance?

A
  • reminder sign on the fridge, bathroom mirror
  • an alarm that tells you why it is going off - like the reminders on the phone
  • step by step written instructions on how to take the meds
22
Q

VA Case Study: You think that Mr. Joseph would best benefit from 4-6 weekly sessions at the clinic. Mr. Joseph tells you that he drives an hour and a half one way in order to get to the clinic and he will not drive that far just to learn his medicines that he has been taking for years. What alternative might you suggest in order to keep Mr. Joseph on track with his treatment plan? Consider utilizing the resource guide for alternative treatment options for Mr. Joseph.

A
  • telehealth
23
Q

Mr. Joseph agrees to try your suggestions for managing his blood sugars at home. What type of system might you use with Mr. Joseph to help track his progress? Keep in mind that you will be seeing him one time per week at the most and that he will be responsible for tracking his progress at home.

A
  • a notebook where he can check off how he did each day taking his medications
  • a column for why he thinks the system didn’t work if he missed a day

Context Final (5 decks)

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