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AGPCNP Board Prep > Ch20: Gerontology > Flashcards

Ch20: Gerontology Flashcards

1
Q

age range: young old, old old, oldest old, elite old

A

young old: 65-74yo

old old: 75-84yo

oldest old: 85-100yo

elite old: >100yo

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2
Q

average life expectancy at:

  • 65yo
  • 75yo
  • 85yo
  • 90yo
  • 100 yo
A 
65yo + 18
75yo + 11
85yo + 6
90yo + 4
100yo + 2

the longer you live, the older you are expected to live

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3
Q

% of population over 65yo that is classified as poor or nearly poor

A

18%

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4
Q

single biggest source of income after 65yo

A

social security (42%)

limited contribution from pension, earnings, assets, and other sources

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5
Q

the majority of elders >85yo [do vs. do not] need assistance with instrumental ADLs

A

do not :)

77% do not need assistance

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6
Q

% of elderly who live alone

A

33%

majority live with a spouse or another relative

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7
Q

Erik Erickson psychosocial task/conflict of old age

A

ego integrity vs. despair

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8
Q

Butler psychosocial/ developmental theory of aging: retrospection and life review results in …. (3)

A

serenity, candor, wisdom

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9
Q

(3) conflicts in Peck psychosocial/developmental theory of aging

A
  • ego differentiation vs. work role preoccupation
  • body transcendence vs. body preoccupation
  • ego transcendence vs. ego preoccupation (happy with what you’ve done, happy with what you’ve accomplished, rather than preoccupied with what you did not)
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10
Q

conflict of Levinson’s season on life psychosocial/developmental theory of aging

A

individual must ultimately come to terms with the inevitability of death

this theory focuses on relationship of physical changes to personality

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11
Q

physiologic theory of aging: gene theory

A

suggests that one or more latent, harmful genes become activated in late adulthood, and the individual cannot ultimately survive

suggests the killer gene was there all along, but remained latent

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12
Q

physiologic theory of aging: error theory

A

as a cell ages, proteins contain more and more errors and eventually a “killer” gene is produced

the more a cell ages and copies, will not work as well as before and more errors accumulate

suggests that errors create a killer gene

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13
Q

physiologic theory of aging: somatic mutation theory

A

there is an active destruction of a key gene that causes cells to stop dividing

longevity depends on how well the cell can repair DNA

suggests that there is a gene that promotes life, allowing cells to survive

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14
Q

physiologic theory of aging: programmed theory

A

a senescence factor (aging factor) accumulates in cells, and then finally begins to act in a dominant factor

the aging factor is dominant to young cells

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15
Q

physiologic theory of aging: immunologic theory

A

imbalance of T cells (cellular immune function),

cellular immune function decreases and auto-antibodies become responsible to the breakdown of the body

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16
Q

physiologic theory of aging: free-radical theory

A

free-radicals are unpaired electrons (circulate as super-oxide O3 and peroxide H2O2 and hydroxyl free radical)

  • three forms of oxygen that are highly reactive or volatile
  • aka, reactive oxygen species
  • forms of oxygen with a loose electron (O2 is stable, but O3 is not. H0 is stable, H2O2 is not, etc.)

unpaired electrons are produced both intrinsically and externally -> altered biochemical reactions thus result in DNA damage and cell death

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17
Q

physiologic theory of aging: cross-link theory

A

collagen molecules cross-link in tissues producing stiffness and rigidity

stiff tissues don’t function very well and eventually die

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18
Q

physiologic theory of aging: stress-adaptation

A

age-related physical changes lead to a decrease in the ability to cope with stressors

related to hypothermia (metabolism slows down, and heat is a byproduct of metabolism), cardiac output decline, and vital capacity result in diminished ability to cope with stress

high degree of variability, which could explain why some people live so much longer than others

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19
Q

author of the transtheoretical model of change - e.g., precontemplation, contemplation, etc.

A

Prochaska

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20
Q

Prochaska’s stages of change in the transtheoretical model of change (5)

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
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21
Q

what is competency?

A

the law presumes that all adults are competent to make decisions regarding their medical care

ONLY a COURT can declare a person incompetent and appoint a guardian to make decisions for them

Impaired judgement does not make a patient incompetent

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22
Q

what is the only entity that can declare a person incompetent?

A

a judge

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23
Q

Does impaired judgement make a patient incompetent?

A

no!

you can have transient delirium, or other acute conditions, rendering unable to provide informed consent but doesn’t make you permanently incompetent

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24
Q

who can determine whether a patient can provide informed consent?

A

providers

does not require a judge, like incompetency does

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25
Q

requirements for the ability to give informed consent (4)

A
  • has knowledge of the diagnosis
  • understands the nature and purpose of the procedure
  • understands the benefits, risks, and side effects
  • understands reasonable alternatives
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26
Q

% prevalence of elder abuse and neglect, current estimates

A

4-10% of elderly Americans

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27
Q

types of elder abuse (5)

A
  • physical
  • sexual
  • psychological/ emotional
  • financial
  • neglect
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28
Q

theories of elder abuse (4)

A
  • cycles of learned violence (we know that people who are abused may be more likely to become abusive; e.g., abused child taking care of abusive parent)
  • caregiver stress (the greater the requirements on the caregiver, the greater risk this relationship could deteriorate)
  • pathophysiology of abuser (?)
  • physical/mental impairment of the elder (the more dependent the patient, the higher the risk)
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29
Q

suspicious indicators of elder abuse

A
  • description of injury does not match physical findings
  • history of similar injuries
  • appears afraid or avoids eye contact
  • flinches when you touch them
  • bruises, burns scratches, lacerations in unusual places
  • injuries in various stages of healing
  • patterns of seeking different health care
  • frequent emergency room use
  • withdrawal from social activities
  • significant changes in affect
  • untreated malnutrition
  • misuse of medications
  • untreated medical needs
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30
Q

Omnibus Reconciliation Act of 1987 provides that every resident of long-term care has the right to be …

A

free from physical or chemical restraint imposed for the purpose of discipline or convenience, and not required to treat medical needs

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31
Q

when injury occurs to an unrestrained patient in long-term care, lawsuits are typically the result of…..

A

failure to meet reasonable standards of care e.g., negligent in duty to provide care for a wandering patient or alarm systems not working

NOT failure of the result to restrain (don’t restrain when not needed!)

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32
Q

methods of decision making for patients who cannot communicate wishes: appointed person

A

appointed person makes decisions based upon their understanding of the patient’s past wishes and values

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33
Q

methods of decision making for patients who cannot communicate wishes: rational approach

A

makes decisions based on what a “rational” person would do under the circumstances

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34
Q

Medicare wants providers to counsel whom about ACPs?

A

all folks 65yo and older

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35
Q

methods of decision making for patients who cannot communicate wishes: substituted judgement

A

attempts to determine what decision the patient would make if they were able

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36
Q

what is the single best method of decision making for patients who cannot communicate their wishes

A

advanced directives!

durable statements of intent based upon the patient’s last written wishes

37
Q

a contract between the patient and HCP which specifies wishes for end-of-life care in terminal events

A

living will

38
Q

a document that authorizes another person to make decisions regarding healthcare when the patient is no longer able to

A

durable power of attorney

39
Q

are advanced directives legally binding?

A

no

and not all states recognize advanced directives legally

even states that do recognize them do so only when the patient is, in the opinion of the HCP, hopelessly and terminally ill

40
Q

which elderly place requires functional ability (e.g., ability to go to bathroom on own?)

A
  • senior care centers
NOT required in:
- adult day care
- home health care
- life care communities
^^ all of these are built to help with folks losing their functional abilities
41
Q

true or false: only a court can declare a person incompetent?

A

true

42
Q

true or false: impaired judgement does not make a person incompetent?

A

true

43
Q

true or false: living wills are generally only honored if a person is terminally ill

A

true

44
Q

true or false: if a person is not declared incompetent, then they can give informed consent

A

false

these are separate considerations; there are some people who haven’t been declared incompetent by a judge who still cannot give consent to a particular situation (e.g., acute delirium)

45
Q

true or false: most elderly live with a spouse or other family member

A

true

46
Q

true or false: almost 25% of elderly over 85yo require assistance with IADLs

A

true

47
Q

true or false; stereotypes about aging have resulted in fiscal policy benefits helpful to elders

A

true

48
Q

true or false: the number of older men in the workforce has increased in recent years

A

false - percentage is decreasing, while percentage of women is increasing

49
Q

which theory of aging suggests that vitamins might delay aging process?

A

free radical theory

reactive oxygen species destroy bonds and ultimately kill cells

in contrast, vitamin E is an example of an antioxidant that could theoretically neutralize free radicals and keep them from destroying cells

50
Q

normal or pathophysiologic change in aging?

increased A:P chest diameter

A

normal change of aging

important to distinguish from COPD via typical history, symptoms, and diagnostic spirometry findings

51
Q

normal or pathophysiologic change in aging?

corneal ring

A

normal change of aging

aka, senile arcus

important to distinguish from HLD, can draw lipid panel

52
Q

normal or pathophysiologic change in aging?

decreased skin turgot

A

normal change of aging

important to distinguish from dehydration, can draw labs for BUN

53
Q

(4) body systems MOST affected by the NORMAL changes of aging

A
  • neurological
  • cardiovascular
  • musculoskeletal
  • lower urinary

because of the weakness in those four organ systems, the strain of any illness tends to manifest in one of these four

predominant cluster of symptoms tends to occur for any illness, e.g., confusion

54
Q

predominant symptom cluster of illness in the older adult (5)

A
  • acute confusion
  • depression
  • falls
  • incontinence
  • syncope

when these occur, can mean anything

e.g., if they have acute onset confusion check for UTI and pneumonia, MI, not suspecting a neurological event first

55
Q

as a consequence of normal age-related declines in compensatory mechanisms, a new illness/ disease may present itself [earlier vs. later]

A

earlier!

as a result, possibly easier to treat

56
Q

in the elderly, heart failure might be precipitated by….

A

mild hypothyroidism

hypothyroidism decreases HR< and combined with age-related decline in cardiac output, cannot compensate as well and thus may present earlier

57
Q

in the elderly, mild hyperparathyroidism may cause….

A

significant cognitive dysfunction via hypercalcemia

less efficient mechanisms for removing and using up calcium

58
Q

3 (D)s that occur more commonly in elderly patients than younger adults

A

dementia, delirium, depression

59
Q

syndrome characterized by deterioration of, or impairment in, behavioral or emotional function despite a state of clear consciousness. distinguished by its persistent, progressive nature.

A

dementia

60
Q

most common dementia

A

Alzheimer’s dementia

61
Q

% of folks at 75yo and 85yo with at least some degree of Alzheimer’s dementia

A

50% by 85yo

25% by 75yo

62
Q

second most common form of dementia

A

vascular dementia

types:

  • multi-infarct dementia (MID)
  • vascular dementia (VaD)
  • dementia with cerebrovascular disease (DCVD)

commonly comorbid with Alzheimer’s dementia

63
Q

what is the cognitive behavioral syndrome of frontotemporal dementia called

A

Pick’s disease

64
Q

Lewy body dementia is characterized by…

A

quick trajectory

65
Q

neurofibrillary tangles are present in what type of dementia

A

Alzheimer’s dementia

66
Q

confabulation typically occurs in which type of dementia

A

Alzheimer’s dementia

67
Q

an acute event characterized by global cognitive impairment, alterations in the sleep-wake cycle, and alterations in psychomotor behavior. distinguished by its rapidly-fluctuating, acute nature. is a symptom, caused by something outside the CNS, not a disease

A

delirium

68
Q

in the elderly population, causation of delirium is usually ….

A

an infection

69
Q

Parkinson’s disease is a degenerative CNS disorder resulting from an imbalance between (2)

A

dopamine and acetylcholine

loss of dopaminergic neurons –> unchecked acetylcholine moving throughout CNS

NOT ENOUGH DOPAMINE

70
Q

(3) classic characteristics of Parkinson’s disease

A
  • resting tremor, e.g., pill-rolling and disappears with purposeful movement
  • rigidity
  • bradykinesia

can progress to impairment in swallowing, decreased automatic movement, and decreased blinking

71
Q

the tremor of Parkinson’s disease would get better or worse with goal-directed movement?

A

better

72
Q

gold standard drug for Parkinson’s disease

A

carbidopa-levodopa (Sinemet)

treats symptomatically, does not deter progression of the disease

73
Q

average duration of response to Sinemet is….

A

5 years

74
Q

all Parkinson’s drugs aim to increase….

A

dopamine availability

75
Q

all Parkinson’s drugs aim to [relieve symptoms vs. stymie disease progression]

A

relieve symptoms

76
Q

% of falls that lead to serious injury

A

11%

77
Q

age-related risk factors for falls

A
  • female
  • chronic medical conditions
  • cognitive impairment
  • ADL dependence
  • impaired vision or hearing
  • polypharmacy
  • environmental hazards
  • gait and balance disorders
78
Q

questions to ask after a fall

A
  • what were you doing when you fell?
  • was there an aura? warning or prodrome that this was going to happen?
  • was there loss of vision? transient vision loss?
  • did you experience vertigo?
  • was there any loss of consciousness?
  • did you break the fall with a hand or other body part?
  • is this an isolated incident or are falls happening more often?
  • what medications are you taking?
  • do you ever drink alcohol?
79
Q

(4) required components of physical exam after a fall

A
  • vital signs, including orthostatic vitals
  • cardiovascular exam
  • sensory assessment
  • gait/balance assessment

other systems as indicated

80
Q

occurs when tissues are compressed or subject to pressure and vascular pressure is exceeded -> lose vascular supply aka ability to provide nutrition to and drain an area

A

pressure ulcer

significant contributing factors include friction, shear forces, and nutritional deficiencies

81
Q

contributing factors to pressure ulcers

A
  • friction
  • shear forces
  • nutritional deficiencies
  • moisture
  • advanced age
  • low BP
  • smoking
  • elevated body temperature
  • dehydration

all of these are things that contribute to decreased tissue perfusion or increased burden on the pressure externally

82
Q

types of ulcers (6)

A
  • pressure ulcer
  • fungal or yeast infection
  • venous insufficiency ulcer (chronic interstitial pressure)
  • PAD ulcer (consequence of poor perfusion)
  • neuropathic ulcer
  • malignancy
83
Q

(2) risk screening tools for ulcers you can use

both of these measure physical, mental, nutritional, mobility, and continence condition

A
  • Braden Scale

- Norton Scale

84
Q

priority intervention for pressure ulcer

A
  • relief of pressure

otherwise, correct risk factors like improving BP, nutritional status, removing shear forces

85
Q

stage 1 pressure ulcer

A

non-blanchable erythema … induration may be present, but NO OPEN AREAS

86
Q

stage 2 pressure ulcer

A

minor epidermal or skin loss, may look like an intact blister

shiny, pink erosion

87
Q

stage 3 pressure ulcer

A

full-thickness skin loss without undermining (not into the deeper structures)

88
Q

stage 4 pressure ulcer

A

full-thickness skin and tissue loss through fascia, muscle, bone or supporting tissue visible

AGPCNP Board Prep (21 decks)

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