Chapter 5 Flashcards
Define the concept of a disease trajectory.
Concept that recognizes that chronic illnesses have multiple phases
Describe the 7 phases of the trajectory model of chronic illness.
- Onset: s/s are present, disease is diagnosed
- Stable: Illness course and symptoms controlled by tx plan, pt is able to maintain everyday activities.
- Acute: Active illness w/ severe symptoms unrelieved. Hospitalization may be needed for management.
- Comeback: Gradual return to an acceptable way of life.
- Crisis: Life threatening situation occurs, emergency services are necessary.
- Unstable: Unable to keep symptoms or disease course under control. Life becomes disrupted while pt works to regain stability. Hospitalization is not required yet.
- Downward: Gradual and progressive deterioration in physical or mental state. Accompanied by increase in disability and symptoms. Continuous change in everyday life activities.
- Dying: Pt has to relinquish everyday life interests and activities, let go, and die peacefully. Includes weeks, days, and hours preceding death.
Describe the 7 tasks of people with chronic illnesses.
- Preventing and managing a crisis: Understanding potential for crisis and how to prevent or modify the threat (adhering to prescribed medical plan. Knowing s/s of onset, crisis, and exacerbation as well as create a plan for each).
- Carrying out prescribed tx plan: maybe challenging (degree of difficulty) or impacts lifestyle (time consuming)
- Controlling symptoms: Modifying lifestyle or living situation to maintain safety (encourage independence in decision making and collaborate w/ HCP)
- Reordering time: change schedule and or eliminate activities.
- Adjusting to change in the course of disease: including the chronic illness and adjusting to the necessary lifestyle changes.
- Preventing social isolation: pt may choose to withdraw or others may withdraw from pt.
- Attempting to normalize interactions with others: managing symptoms to take focus off of disability/disfigurement
Describe the key factors that impede health care access in rural older adults. (5)
*#1: transportation
*Limited supply of healthcare workers and facilities
*Lack of quality health care
*Social isolation
*Financial limitations
Describe the impact homelessness has on the mortality of older adults. (4)
*Homeless older adults face higher mortality rates due to lack of housing and limited access to aging network services.
*They are at increased risk of health problems, as they often avoid shelters and meal services, fearing institutionalization.
*Providing care requires a coordinated effort involving various professionals and services, including outreach, primary care, Medicare/Medicaid, pharmacies, and senior centers.
*Long-term care placement is often chosen over homelessness, particularly for those with cognitive impairment.
Describe how homeless older adults are more at risk for health problems. (2)
*Not many networks specializing in both older adults and homelessness
*Less likely to utilize shelters and meal services (may be due to fear of institutionalization)
Describe the 5 manifestations and physical characteristics of a frail older adult.
*To be properly diagnosed, must have three or more of the of these characteristics
1. Unintentional wt loss (10lbs or more in year)
2. Self-reported exhaustion
3. Weakness (measured by grip strength)
4. Slow walking speed (decreased from baseline)
5. Low level of physical activity
Define elder mistreatment. (2)
*Intentional acts of omission or lack of compassion by caregiver or “trusted other” that causes harm or serious risk for harm to a vulnerable older adult.
*May occur in community or long-term care setting
Outline the 6 factors that make community-dwelling older adults at risk for elder mistreatment.
- Physical or cognitive dysfunction that leads to an inability to perform ADLs
- Psychiatric disorders (ex. Dementia, depression, etc.)
- Alcohol misuse
- Decreased social support
- Living with a large number of household members besides spouse
- Low income
Describe the 7 types of elder mistreatment.
- Abandonment: desertion of older adult (OA) by person who is responsible
Manifestations: OA reports being abandoned, desertion of OA in hospital, SNF, mall, etc. - Financial: denying access to personal resources, stealing money or possessions
Manifestations: living situation is below financial status, low level of personal resources, Sudden change in finances, sudden asset transfer. - Neglect: failure to provide basic needs or physical aids.
Manifestations: reported from OA, untreated infection or pressure injuries - Physical: slapping, striking, restraining, incorrect positioning.
Manifestations: bruises, B/L injuries, repeated injuries, burns, multiple ER visits at multiple different ERs - Psych: Berating, harassment, intimidation, threats, isolation
Manifestations: depression, withdrawn behavior, agitation, ambivalent - Sexual: non consensual sexual contact
Manifestations: OA report, unexplained vaginal/anal bleeding, bruising, unexplained STIs - Violation of personal rights
Manifestations: sudden inexplicable change in living situation
3 factors that precipitate placement in a long-term care facility
- Rapid deterioration of function
- Caregiver stress burnout
- Alteration in or loss of family support system
Describe the cascade disease pattern and how it impacts the health of older adults. (3)
- Adult w/ preexisting condition (ex. insomnia)
- Adverse event occurs d/t or r/t condition (ex. Takes sleeping meds, causing pt to become lethargic, leading to the patient falling)
- This event leads to progressive deterioration (ex. Decrease in activity or mobility leads to pneumonia)
Describe how pre-existing conditions and deconditioning influence the outcomes of rehabilitation of older adults.
*anxiety
*fear or concern about falling
*Poor nutrition and financial issues
*older adults often lose function because of inactivity and immobility.
*lack of motivation to stay fit
