Chapters 11 & 12 - Foundations of Gerontology: Theories of Aging, Care of the Frail Elder & Prescribing to the Elderly Population Flashcards
1
Q
What are the living arrangements for elders?
A
- Only 25% of the population > 95 living in LTC
- The majority of elderly live with a spouse or other relative
- 75% of men live with spouses
- 39% of women live with spouses
- 33% of elderly live alone
2
Q
Common threads among developmental tasks of aging
A
- Adjust to decreasing physical strength and health
- Adjust to retirement and reduced income
- Adjust to death of a partner
- Establish affiliation with peers
- Adapt to social rules
- Establish satisfactory physical living arrangements
3
Q
What are the stages in the Transtheoretical Model of Change
A
- Precontemplation – no intention to make change within the next 6 months
- Contemplation – intending to change within 6 months
- Preparation – ready to take action, already have taken some action
- Action – have made specific overt modifications that attains a criterion sufficient to reduce risk of disease
- Maintenance – working to prevent relapse
4
Q
Competency
A
- The law presumes all adults are competent to make decisions
- Only a court can declare a person as incompetent and appoint a guardian
- Impaired judgement does not make a person incompetent
- When obtaining informed consent the patient: has knowledge of diagnosis, understands nature and purpose of procedure, understands benefits/risk/side effects, understands reasonable alternatives
5
Q
Theories of elder abuse
A
- Cycle of learned abuse
- Caregiver stress
- Pathophysiology of abuser – psychologic issue, substance abuse, etc.
- Physical/mental impairment of the elder
6
Q
Organ systems most affected by the age-related decline
A
- Neurological
- Cardiovascular
- Musculoskeletal
- Lower urinary
7
Q
Atypical presentation of illness in the elder
A
- Because of the weakness of the 4 organ systems most affected by age-related decline (neurologic, musculoskeletal, cardiovascular, lower urinary) the strain of illness or disease in any body system tends to manifest in one of these four
- In the geriatric patient, the organ system associated with a particular abnormality or problem is less likely to be the source of the problem in the younger adult
- Diseases usually present at an earlier stage as a result of normal, age-related decline in compensatory mechanisms
8
Q
What is dementia (general)?
A
- A syndrome characterized by deterioration of or impairment in mental, behavioral, or emotional functions despite a state of clear consciousness. The persistent stable/progressive nature of the impairment distinguishes it from delirium
- Types – Alzheimer’s dementia, vascular dementia, Parkinson’s dementia, Lewy Body dementia, Pick’s disease, subcortical dementia
9
Q
What is Alzheimer’s dementia?
A
- Most common type of dementia
- Patients are very animated (either happy or angry) and as the disease progresses, the more extreme the animation
- Confabulation is characteristic as well as paranoia (especially as disease progresses)
- 10% > 65 years, 25% > 75 years, 50% > 85 years old
10
Q
What is vascular dementia?
A
- Second most common type of dementia
- Almost half of vascular dementia cases also have an Alzheimer’s component
- Multi-infarct dementia (MID), dementia with cerebrovascular disease (DCVD)
- Tends to have a more flat mood
11
Q
What is delirium?
A
- Acute event characterized by global impairment, alteration in sleep-wake cycle, and alteration in psychomotor behavior
- Its acute and global nature distinguishes it from dementia
- Patient safety is primary concern
- Management should include simple firm communications, reality orientation, validity of feelings, a visible clock, and the presence of a familiar person if possible
- Drug-therapy as indicated for safety – short-acting, low anticholinergic properties
12
Q
What is Parkinson’s Disease?
A
- Degenerative CNS disorder resulting from an imbalance of dopamine and acetylcholine (too little dopamine, too much acetylcholine)
- Characterized by any combination of tremor, rigidity, and bradykinesia
- Resting tremor (e.g., “pill rolling”) often disappears with purposeful movement
- Pharmacologic options focus around trying to increase amount of dopamine
- Carbidopa-Levodopa (Sinemet) – gold standard, treats symptoms
- Others: selegiline, dopamine agonists, COMT inhibitors
13
Q
General facts about falls
A
- Falls represent a significant source of morbidity and mortality in the elderly
- Multiple falls are associated with increased risk of death
- Biggest risk factor for falls = previous fall
- Age-related risk factors: female, chronic medical conditions, cognitive impairment, ADL dependence, impaired vision/hearing, polypharmacy, environmental hazards, gait and balance disorders
14
Q
Non-pharmacologic interventions to falls
A
- Review mediations; assess doses, eliminate high-risk drugs
- Prevention/treatment of osteoporosis
- Recommend proper footwear
- Obstacle-free, well-lit environment
- Raise chair heights, seat heights, add arm rests
- Physical therapy as indicated
- Counsel avoidance of quick position change
15
Q
General facts about pressure ulcers
A
- Pressure ulcers occur when tissues are compressed and vascular pressure is exceeded
- Significant contributing factors include friction, shear, and nutritional debilitation
- Other contributing factors – moisture, advanced age, low BP, smoking, elevated body temperature, dehydration
- Differential dx – conditions that mimic pressure ulcers, fungal and yeast infections, malignancy, venous and arterial ulcers, neuropathic ulcers
16
Q
Staging of pressure ulcers
A
- Stage 1 – non-blanchable erythema of intact skin; induration may be present
- Stage 2 – epidermal or dermal skin loss, may appear as intact blister
- Stage 3 – full thickness skin loss, deep crater without undermining
- Stage 4 – full-thickness skin and tissue loss; through fascia, muscle, bone, or supporting tissue visible
17
Q
What is Beers Criteria?
A
- Lists of certain medications that you should think about that may not be the safest or best option for older adults
- Helps guide clinicians away from potentially harmful treatments
18
Q
Normal age-related physical changes: skin
A
- Loss of skin turgor – d/t decreased subQ tissue, can also be abnormal (ex: dehydration)
- Senile keratoses – benign overgrowths, look like barnacles
- Senile lentigo – hyperpigmented macules
- Decreased perspiration and poor temperature regulation
