Cases exam 2

Question 1

Graph of the prevalence of drinking patterns in older adulthood
Abstainers being the most and Alcohol abuse or dependence being the least

Answer 1

(Fleming et al., 1999; Blow, CSAT, 1998)

Question 2

Limits for older women should be somewhat lower than those for older men

Answer 2

(NIAAA, 1995; DuFour and Fuller, 1995)

Question 3

Older women may be at greater risk for alcohol problems due to potential loneliness and depression from outliving spouse, other losses
Physiologically at greater risk as they age
Screening and brief intervention useful

Answer 3

(Blow and Barry, 2002; Fleming, et al, 1999)

Question 4

Moderate alcohol consumption has been demonstrated to increase the risk of strokes caused by bleeding, although it decreases the risk of strokes caused by blocked blood vessels

Answer 4

(Hansagi et al., 1995)

Question 5

Moderate alcohol use has also been demonstrated to impair driving-related skills even at low levels of consumption and it may lead to other injuries such as falls

Answer 5

(Kivela et al., 1989)

Question 6

Alcohol is also known to interfere with the metabolism of medications such as digoxin and warfarin

Answer 6

(Adams, 1995; Fraser, 1997; Hylek et al., 1998)

Question 7

, a former history of alcohol use had an odds ratio of 2.2 in predicting impairment in ADL’s among older women

Answer 7

(Ensrud et al., 1994)

Question 8

several authors have demonstrated that among older community dwelling persons moderate alcohol use is associated with fewer falls, greater mobility and improved physical functioning when compared to a comparison group of non-drinkers

Answer 8

(Nelson et al., 1992; 1994; LaCroix et al., 1993; O’Loughlin et al., 1993)

Question 9

studies suggesting that alcohol consumption in older persons may exhibit a protective effect in moderate doses

Answer 9

(Scherr et al., 1992)

Question 10

A few studies do indicate that dual diagnosis with alcoholism is an important concern among elderly individuals

Answer 10

(Finlayson et al., 1988; Blow et al., 1992a; Blazer & Williams, 1980; Saunders et al., 1991; Oslin et al., 2000)

Question 11

Depressed persons who are alcohol dependent have been shown to have a more complicated clinical course of depression with an increased risk of suicide and more social dysfunction than non-depressed alcoholics
Found that a prior history of alcohol abuse predicted a more severe and chronic course for depression

Answer 11

(Cook et al., 1991; Conwell, 1991)

Question 12

Among subjects over the age of 55 evaluated in the ECA study, the prevalence of a lifetime history of alcohol abuse or dependence was 1.5 times greater among persons with mild and severe cognitive impairment than those with no cognitive impairment

Answer 12

(George et al., 1991).

Question 13

Alcohol causes well-established changes in sleep patterns such as decreased sleep latency, decreased stage IV sleep, and precipitation or aggravation of sleep apnea

Answer 13

(Wagman et al., 1997)

Question 14

. Overuse, underuse, or irregular use of either prescription or over-the-counter drugs are all forms of drug misuse. In its extreme form, misuse may become drug abuse

Answer 14

(Patterson & Jeste, 1999; Ellor & Kurz, 1982)

Question 15

Studies report that older persons regularly consume on average between two and six prescription medications and between one to three over-the-counter medications

Answer 15

(Larsen & Martin, 1999)

Question 16

Combined difficulties with alcohol and medication misuse may affect up to 19% of older Americans

Answer 16

(Bucholz et al., 1995; D’Archangelo, 1993; NIAAA, 1998a, 1998b)

Question 17

Factors such as previous or coexisting drug, alcohol, or mental health problems, old age, and being of the female gender also increase vulnerability for misusing prescribed medications

Answer 17

(Finlayson, 1995a, 1995b; Finlayson & Davis, 1994; Cooperstick & Parnell, 1982; Sheahan et al., 1989)

Question 18

“Advance directive: written statement that directs health care providers concerning consent or refusal of treatment when the individual patient does not possess decision-making capacity”

“Living will: document that establishes a written mechanism for an individual to specify wishes about withdrawing or forgoing life-sustaining treatment (treatment that only prolongs or delays the process of dying).”

Answer 18

(Brent, N.J, 2001. Nurses and the Law.pg.216)

Question 19

Race generally defined as a biological factor of discrete group whose members share distinctive genetic, biological, and other factors from a common or claimed or ancestor.
Culture (holistic in meaning) and ethnicity (often based on national origins) cannot be used interchangeably; whereas race and ethnicity have different meanings, but often are used interchangeably

Answer 19

(Kottack, P., 1991. Anthropology: The exploration of human diversity, pg. 69)

Question 20

Cultural marginality
Attitudes include:
Passive betweeness (lack of belonging in either culture)
Establishing new relationships in midst of old relationships
Emotional conflict and struggle
Anxious/hopeful promise

Answer 20

(Heesung, Choi, DSN (UTH,SN 2004)

Question 21

Six Cultural Phenomena

Answer 21

(adapted from Giger, J.N. & Davidhizar, 1995)

Question 22

Four-Step Approach to Providing Culturally Sensitive Care

Answer 22

(Price, J.L. & Cordell, B., 1994)

Question 23

Cultural Systems in the Context of Health and Illness Care

Answer 23

(adapted from Anderson, J.M., 1987)

Question 24

Selected Domains of Culture

Answer 24

(Purnell & Paulanka, 2003, p. 111)

Question 25

Additional Group to be Considered

Answer 25

Edelman & Mandle (2006)

Question 26

1987 - Omnibus Budget Reconciliation Act
Requirements:
- Use of a standardized assessment tool (MDS);
- Timely development of a written care plan.
- Reduction in use of restraints & psychotopic drugs
Increase in staffing
Protection of residents’ rights.
Training for nursing assistants
Deficient nursing homes could receive sanctions

Answer 26

(Eliopoulas, 2005)

Question 27

ACE Units

Answer 27

(Thomas, 2002; Miller, 2004)