exam 1 Flashcards
todays older adults vs past adults
todays adults are healthier and better educated, and are expected to have a higher quality of life
what is the john hartford foundation
major contributor to the specialty of gerontological nursing. They gave us alot of the basis
what has research allowed for improvements in
dementia care
safety and restraint use
pain management
end of life care
what does acute care focus on
promotion of health and maximal independence.
They are patient centered and have interdisciplinary teams, and a home-like atmosphere
factors that could change a cultures definition of old
functional
social
biological
chronological (age number)
super centenarians
People who live to 110 and older
typically woman, Japanese
centenarians
Age 100-109
primarily woman in southern states
those in between (generational subgroups)
those born between 1920 and 1945
ages 79-104
baby boomers
born between 1946 and 1964
ages 60-78
born 18 years after WWII
what do we want with healthy aging
Want them to reach their optimal level of health- its defined differently for each individual
culture
the shared and learned values, beliefs, expectations, and behaviors of a group of people
what is diversity based off
religion, race, language
there is 7 ethnoracial groups in the US
Disparity
differences in health outcomes between groups
-same disease but different outcome
ex- African americans are twice more likely to die from diabetes then whites
inequity
the excess burden of illness or the difference between an expected incidence and prevalence
- not due to a group but more so lack of resources
where is disparity and inequity typically seen
older adults of minority ethic or racial groups
3 types of health belief models
Western (Biomedical)
personalistic (magicoreligious)
naturalistic (holistic)
western belief model
disease is caused by invasion of pathogen and treatment focuses on destruction of this said pathogen
personalistic belief model
belief in a supernatural entity causing illness
rituals are performed to over come it, could be like praying
naturalistic belief method
based on concept of balance
disturbance of balance=illness
restore balance for treatment.
biological aging
Attempting to explain changes in organisms. As you use things it wears out.
increased rate of cellular deterioration and vulnerability to disease
Free radicals aging
things that are bad for you tear your body down and damage cells
due to ROS (reactive oxygen species)
can be prevented by healthy living
what increases ROS
Pollution
cigarette smoke
inflammation
inflamm-aging
suggest aging is a result of accumulation of damage to the immune system, or immunosenescence
the higher the immune system the better. encourage vaccines
key factor in aging process
chronic state of inflammation and increased number of ROS
Mitochondrial dysfunction
free radicals and ROS damage cause mutation of mitochondria, associated with neurodegenerative disorders
epidermis and aging
blood vessels and bruising more visible
fewer melanocytes
lentigines appear (freckling)
thins
dermis and aging
collagen synthesis decreases
elastin fibers thicken, resulting in “sagging” appearance
thins
hypodermis and aging
atrophy
sensitivity to cold
less oil secretion
changes in hair and nails
increased hair in ears, nose, eyebrows
women get chin hair
hair loss of pigmentation (greys)
decreased hair on extremites
nails become harder, thicker, brittle and dull
vertical ridges and slow growth
musculoskeletal changes
ligaments, tendons, and joints become dry, hardened and less flexible.
muscle mass decreases
vertebral disk thin
balance issues (inner ear changes)
cardiovascular changes w aging
left ventricle thickens
decrease in coronary artery blood floe, stroke, volume and cardiac output
blood vessel elasticity decreases
veins become stretched and valves are less efficient, varicose veins and edema may occur
respiratory changes and aging
loss of recoil
chest wall stiffens
gas exchange less efficient
cough effectiveness reduces
cilia are less effective
renal changes with aging
kidney blood flow decreases
size and function decreases
elasticity of bladder decreases- could lead to urinary retention then uti
increased susceptibility to fluid and electrolyte imbalance
endocrine changes and aging
most glands shrink
increased insulin resistance
GI changes and aging
teeth loose enamel
fewer taste buds- decreased appetite
decreased salivary secretion
slow emptying of stomach
decreased gastric mobility
decrease intrinsic factor
peristalsis slows, constipation common.
Eat high fiber meals!
what memory is effected first in aging
short term
eyes and vision changes w aging
near vision decreases
less reactive to light (needs to be brighter)
dry eyes
increased risk for glaucoma
decline in peripheral vision
what hearing loss is most common in aging
high frequency sounds
body temperature and aging
oral temp is lower (96 F)
low grade fever could indicate significant illness
psychosocial aging theory first generation examples
role theory
activity theory
psychosocial aging second generation theories
disengagement theory
continuity theory
age stratification theory
social exchange theory
modernization theory
developmental theory
gerotranscendence theory
role theory
We develop roles for ourself in life, our identity,
If things change it could effect self esteem
self identity is believed to be defined by ones role in society
active theory
Activity increases ability to stay healthy
disengagement theory
People often step back here and decide to let others take over
a slow withdrawal from society to transfer powers
continuity theory
people develop and maintain a consistent pattern of behavior, like still wanting to play cards often
age stratification theory
believes in age categories of the older population. consideration of experiences similar to others in the cohort
social exchange theory
marginalizes those who struggle financially
modernization theory
value in older adults is lost when their skills are no longer considered useful, could be from technology, urbanization, etc
developmental theory
predetermined order of developmental stages, like eriksons
gerotranscendence
focuses on what they want out of life, withdrawal from society for self reflection
this is a marker of successful aging
third generation theory
the life story.
recalling their past, we encourage this
adult cognition
process of acquiring, storing, sharing and using info.
the things we have done play into who we are now
includes language, thought process, memory, execution of function, judgement, attention, perception
fluid intelligence
ability to logically think through a problem
street smart
crystallized inteligence
long lasting and improves with age
book smart
learning later in life
keep info relevant and simple
must relate to what the older person already knows
program for all inclusive care for the elderly (PACE)
medicaid and medicare program. A community based care of individuals that meet nursing home requirements. It covers cost of primary care, hospitalization, ER visits, approved specialty visits, rehab, home care, meds and treatments, and recreational options.
requirements for nursing home
around the clock care that cant be provided else where
Assisted living facility
more independence than nursing home. they may need help with things like dressing, bathing, etc.
often may move to a nursing home
median stay is 22 months
adult day care
for adults who need safe setting in the day
sub acute care
more intense than nursing home, and short term
pricy but cheaper then being in hospital
goal is to discharge home or to a less intense setting
how is care paid for
medicaid
medicare- most common
out of pocket
most common reason for readmission of elderly
confusion with medications
late life income
social security- pay as you go system
supplemental security income- stipends to low income people who are above age 65, or blind/deaf/disabled
some people may also have pensions and private retirement investments
medicare
must be eligible for social security
cost covered by employer and employee tax
medicare A
Enrolled automatically on 65th birthday
covers acute care or short term rehab
medicare B
must apply within 6 months of 65TH birthday
designed to cover outpatient and ambulatory services
pt may be responsbile for deductible, copays
medicare C
offers medicare advantage plans like insurance
extra premiums may be required
medicare D
Optional prescription coverage
supplemental insurance
medigap
monthly premium paid
covers all copays and deductibles
medicaid
for low income
covers more services then medicare
tricare for life (TFL)
no premium medigap insurance
provided by department of defense
requires enrollment in medicare A and B, gov helps with extra assistance
Who can declare a person incapacitated
courts only
power of attorney (POA)
chosen by individual not court
legal document designing another person the power to act
general POA
right to make financial decisions
durable POA
health care related decisions when a person is unable to decide for themself
health care proxy
a hierarchy of those who have authority to act on a person behalf when capacity is lost temporarily ot permanently
first is guardian, then spouse, then majority of adult children, then parents, then adult siblings, then close friend, then social worker
guardian
a person appointed to be responsible for another person (by court). Doesn’t make all of decisions
conservator
a person specifically appointed to control, makes all the decisions
warfarin (coumadin)
check PT and INR
INR 2-3 seconds is therapeutic range
Anticoagulant, prevents blood clots
Vitamin K messes this up limit salads, collard greens
Vitamin K is reversal.
Limit aspirin
Alteplase (activate, TPA)
thrombolytic agent. Check aPT, Therapeutic is 25-31 seconds
Monitor platelet, Hgb, Hct
Reversal- antihistamine, corticosteroids
Given after a clot has occurred
Do neuro checks
heparin
protamine sulfate is reversal. Treats or prevents clots (anticoagulant), Look for bleeding, bruising, unclear urine
Clopidogrel (Plavix)
anti-platelet. To prevent clots and stroke. Don’t take with aspirin. Use electric razors, soft toothbrush. Avoid alcohol
