Chronicity

Question 1

Factors that influence healthy aging

Answer 1

Preventative care
Healthy diet
Exercise
Social determinants of health
Minimising stress
Genetics

Question 2

Age related changes in sleep

Answer 2

• Decreased REM sleep
• Increased in light sleep
• Decrease in strength of circadian regulation
• Decrease in upper airway mass/tone = OSA

Question 3

Age related changes in CNS

Answer 3

• Decreased memory recall
• Cerebral atrophy
• Decreased neurotransmitters
• Decreased nerve impulse transmission = slow reaction time

Question 4

Age related changes in eyesight

Answer 4

• Decreased pupillary response
• Loss of peripheral vision and decreased depth perception
• Sensitivity to glare, less light hits retina
• Decreased discrimination of colours
• Increased eye disease

Question 5

Age related changes to senses

Answer 5

• Reduced hearing
• Reduced eye sight
• 50% less taste buds by 80
• Reduced sense of smell
• Reduced sensitivity to touch

Question 6

Age related changes in body temp control

Answer 6

• Difficult to regulate temperature due to changes in nervous system and some medications

Question 7

Age related changes in cardiovascular system

Answer 7

• Less efficient under stress
• Reduced SV
• Decreased elasticity in blood vessels
• Increased arteriosclerosis = HTN

Question 8

Age related changes in resp system

Answer 8

• Decreased lung compliance/elasticity
• Decreased muscle strength and less efficient gas exchange under stress

Question 9

Age related changes in renal system

Answer 9

• Reduced number of nephrons so kidneys less efficient
• Decreased bladder capacity
• Benign prostate enlargement

Question 10

Age related changes to GI system

Answer 10

• Dental deterioration
• Decreased saliva production
• Decreased nutrient absorption
• Decreased gastric motility and secretions
• Blunted thirst which masks onset of dehydration

Question 11

Age related changes to immune system

Answer 11

• Increased autoimmunity
• Decreased resistance to infection
• Febrile response significantly lower

Question 12

Age related changes in skeletal system

Answer 12

• Decreased muscle strength
• Decreased calcium in bones = decreased bone mass
• Degeneration of joints

Question 13

Age related changes in muscular system

Answer 13

• Reduced muscle mass by 15-40%
• % of fat to muscle mass decreases

Question 14

Age related changes in peripheral nervous system

Answer 14

• Peripheral neuropathy
• Impaired autonomic response time (e.g. decreased temperature control)

Question 15

Age related changes in skin

Answer 15

• Decreased sweat production = impaired cooling
• Decreased tissue turgor
• Dry
• Less elasticity
• Thinning and fragile
• Nails tougher, brittle and thick

Question 16

Dementia (major neurocognitive disorder) criteria

Answer 16

• Cognitive deficits that interfere with independence and are gradual in onset
• Difficulties with: concentration, learning new things and recalling memories, managing complex tasks and previously familiar activities, language, choosing how to behave socially, using insight

Question 17

Mild neurocognitive disorder criteria

Answer 17

• Concern from the individual, informant or clinician
• A modest impairment in cognitive performance
• Cognitive deficits do not interfere with capacity for ADLs but require greater effort, compensatory strategies or accommodations

Question 18

What are important factors to assess when assessing the health of older adults?

Answer 18

Look beyond the persons symptomology
- Physical environment
- Psychosocial wellbeing
- Spiritual needs
- Hobbies and interests
- General health
- Wishes and goals

Question 19

What is involved in assessing and responding to care needs of older adults under consumer directed care?

Answer 19

Provide documented evidence that our assessment and responses to care needs are focused on:
- providing person-centred care, including support for carers
- recognising that consumers are active partners and have strengths as well as problems
- using those strengths to increase the person’s choice and control
- providing the right care in the right place at the right time
- proactively promoting health and encouraging protective health behaviours
- building a whole-of-service-system response (e.g. engaging GPs as part of a multidisciplinary coordinated approach)

Question 20

What are the 5 elements that are essential to ensuring an older adult’s emotional wellbeing?

Answer 20

1. Resilience and coping
2. Productive contributions
3. Social connections
4. Comfort and basic needs
5. Sensory enrichment

Question 21

What are some cognitive effects of dementia?

Answer 21

• Difficulty concentrating
• Difficulty completing complex tasks
• Reduced memory
• Reduced ability to learn new things

Question 22

Why should person centred care be used for behaviours and psychological symptoms of dementia?

Answer 22

There are different reasons for the presentation of these symptoms. For example, aggression can be in response to pain or frustration, therefore instead of just giving antipsychotics or benzodiazepines to sedate them, learning more about them and their history can help settle the behaviours

Question 23

What is the PAS?

Answer 23

Psychogeriatric assessment scale - used in people displaying symptoms of dementia, stroke or depression and used to get a better understanding of the cause as depression and dementia can often look similar

Question 24

Examples of behavioural symptoms in BPSD

Answer 24

• Activity disturbances - agitation, restlessness, hyperactivity, wandering, inappropriate activity
• Aggression - verbal and physical
• Appetite and eating disorders
• Disturbed sleeping and waking cycle
• Socially unacceptable behaviours

Question 25

What are common symptoms in palliative care?

Answer 25

• Anorexia
• Dyspnoea
• Abnormal breathing patterns
• Congestion
• Nausea and vomiting
• Dehydration
• Restlessness
• Disorientation/confusion
• Fatigue
• Constipation
• Diarrhoea
• Pruritus
• Spiritual distress
• Depression
• Xerostomia

Question 26

What are the two legal processes in palliative care?

Answer 26

Advanced care planning and voluntary assisted dying

Question 27

What is the chronic care model?

Answer 27

The person with a chronic illness is involved in their care, thus supporting a partnership with the healthcare team to support self management. Not just a model for individual care, but for larger populations of individuals. It does not redesign patient care, instead, it redesigns clinical practice that are delivering care by implementing system and process change

Question 28

What is the National Strategic Framework for Chronic Conditions (NSFCC)? What does success look like?

Answer 28

A framework focusing on providing better care for people with chronic illnesses.
1. Australians with chronic conditions receive coordinated, person-centred and appropriate care
2. Australians experience fewer complications, multi-morbidities or disabilities associated with chronic conditions
3. Fewer Australians die prematurely due to specific chronic conditions

Question 29

What are the 3 objectives of the NSFCC?

Answer 29

1. Focus on prevention for a healthier Australia
2. Provide effective and appropriate care to support people with chronic conditions and optimise quality of life
3. Target priority populations

Question 30

Why is targeting priority populations an objective for this framework?

Answer 30

There is a disproportionate burden of chronic conditions in priority populations, so there is a need for targeted actions to optimise equal health outcomes for everyone by focusing on health equity

Question 31

How can health systems create health equity for priority populations?

Answer 31

• Practise cultural safety
• Ensuring access to health services
• Optimise the effectiveness, quality and affordability of health services
• Ensuring flexible service options

Question 32

What are the 5 ways to provide efficient, effective and appropriate care to support people with chronic conditions to optimise quality of life?

Answer 32

1. Active engagement
   - Person-centred care, include patients in their care, allow them to make decisions and self manage their condition
2. Continuity of care
   - Holistic, continuous, ongoing care is provided to ensure they are managing their condition, and ensure the care is coordinated across the healthcare system
3. Accessible health services
   - Equitable access to health services
4. Information sharing
   - Effective, secure and efficient ways to share patient information between health services to improve service delivery and health outcomes
5. Supportive systems
   - Systems working together to better meet the needs of people with chronic conditions

Question 33

Nursing roles/care for people with chronic conditions

Answer 33

1. Person-centred care and support for self-management
   - Educate patients how to self-manage their condition (medications and symptom education)
2. Supporting partnerships
   - Improve partnerships and collaboration between services to strengthen the health system and improve outcomes
3. Interdisciplinary teams
   - Work with medical and allied health practitioners to coordinate care, undertake assessments and monitoring, support treatments, work with colleagues to tailor treatments to the individual’s self-management care needs
4. Case management and care coordination
   - Support adults with chronic conditions to self-care and navigate services in inpatient and community settings
5. Supporting service navigation
   - Work with patients to manage and navigate multiple health services that the patient requires to self-manage their health conditions

Question 34

Important headings in concept maps

Answer 34

1. Story
2. Unwell
3. Activities
4. Communication
5. Environment
6. Strengths