Exam 2 - Study Material Flashcards
What is aging in place?
Allowing older adults to remain in their own homes and communities for as long as possible, thus minimizing traumatic uprooting moves to other residential and care settings.
What are some services that may foster “aging in place”?
Personal Care
- assistance with ADL’s (caregiver)
- home health care
Nutrition
- meal preparation
- nutrition sites
- home delivered meals or groceries
Home Maintenance
- home repair &/or modifications
- housekeeping
- yardwork
Transportation:
- shopping, medical appointments, etc.
Emergency call/response systems
- Life line
What are design features that increase safety and foster aging in place?
- Ramps
- Side rails
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What are potential reasons for the elderly moving?
- Income
- Health hazards
- Not able to walk
- To move closer to the family
- Chronic illness
- Disability
What is a least restrictive living envrionment?
A living arrangement which maximizes choice and minimizes lifestyle disruption.
What is a single-family residence?
Home that is owned or rented by an elder who lives alone, with a spouse, significant other, or other family members.
What are “seniors only” apartments?
- Individual apartments within a specially designed, multi-unit dwelling.
- Apartments restricted to seniors.
- Some older adults sell their homes of many years and move to an apartment.
- Pros: You are around people their age
- Cons: The’re around only people their age, restricted only to seniors
What are retirement communiities?
- Residential development designed for independent, active elders.
- Owned or rented units.
- Offer amenities, recreational activities, and services that cater to residents e.g., meals, transportation, housekeeping, golf, tennis, swimming pool, spa, and a variety of clubs and interest groups.
- Services purchased
- Pros: Great activities for the elders
- Cons: Cost might be an issue
What are continuing care retirement communities?
- Offers “life care”; provide a full range of services & accommodations to meet each resident’s needs as they change.
- Provide multiple levels of care including independent, assisted living, & skilled nursing.
- May require buy-in or entry fee followed by monthly payments covering rent, services, amenities, and medical assistance. Entry fee may be refundable in part, or not at all.
- Pros: Provides long term care
- Cons: Very expensive
What is ECHO Housing/Granny Flat?
- Second family living unit or apartment with a separate entrance located on a single family lot.
- May be a pre-fabricated housing unit.
- Fosters affordable housing.
- Aids families with elderly parents unable to live completely alone.
- Pros:
- Cons:
Describe shared housing
- Group residence with shared common areas.
- Each person has a private bedroom & shares rest of house, as well as expenses & chores.
- Professional organizations which specialize in these arrangements match the two parties based on needs and abilities.
- Pros:
- Cons:
Describe HUD or federally funded housing
- Government subsidized apartments architecturally designed for elders and may include disabled individuals including younger age groups.
- Monthly rents vary according to income (sliding scale), apartment size, and services received. Income and expenses are verified.
- Pros: Cheap
- Cons: Could be suspecible to crime
What are assisted living facilities?
- Private apartments – residents receive assistance with non-medical aspects of daily activities (e.g. meals, personal care, housekeeping, laundry, transportation, & medication supervision prn).
- 1 or 2 rooms & bathroom; share common areas for meals and social activities.
- May be a part of CCRC, N.H., or stand alone.
- Licensure required in TX (Agency: DADS) and nursing homes
- Pros:
- Cons:
What are personal care homes?
- Provides board and care and supervision for 4-10 residents in a homelike setting.
- Designed for individuals who do not require professional nursing care, but need considerable personal care and assistance.
- Often a home is renovated or converted for this purpose.
- Licensure required in TX (Agency: DADS)
- Pros:
- Cons
What is Skilled Nursing/Long Term Care Facility (N.H.)?
- Provide round the clock personal care (skilled care also for some facilities).
- May specialize in short-term or acute nursing care, intermediate care or long-term skilled nursing care, & rehab.
- May be freestanding or part of a seniors community.
- Licensure required in TX (Agency – DADS)
What did the social security act pass?
}provided additional funds for purchase of services.
Some facilities opened, offered room & board, & personal care services.
What does the Omnibus Budget Reconciliation Act require?
- Use of a standardized assessment tool (MDS);
- Timely development of a written care plan.
- Reduction in use of restraints & psychotopic drugs
- -Increase in staffing
- -Protection of residents’ rights.
- -Training for nursing assistants
- -Deficient nursing homes could receive sanctions
What are the bill of rights for LTC/NH residents?
The right to:
- Voice grievances and have them remedied.
- Information about health conditions & treatments and to participate in one’s own care.
- Choose one’s own health care providers & to speak privately with him/her.
- Consent to or refuse all aspects of care & treatment.
- Manage one’s own finances if capable.
- Be transferred or discharged only for appropriate reasons.
}Be free from all forms of abuse.
- }Be free from all forms of restraint to the extent compatible with safety.
- }Privacy & confidentiality concerning one’s person, personal information, & medical information.
- }Be treated with dignity, consideration, & respect in keeping with one’s individuality.
- Immediate visitation & access at any time for family, healthcare providers, & legal advisors
What are alzheimer’s facilities?
What is an adult day care?
- Provides supervision, meals, medication administration, and social & recreational activities during day hours. Some provide health-related services and transportation.
- Provide respite for caregivers.
- Convenient for families who work during the day.
- Reimbursed by Medicaid.
What are ACE (acute care for elderly) units?
- Geriatric unit in the hospital staffed by a multidisciplinary team.
- Designed to address acute care needs of older adults.
- Research –Outcomes:
- Improved functional status
- Fewer discharges to NH
- Better 1 yr. survival rate compared to elders receiving usual hosp. care.
- Major focus on rehab. & prevention of disability.
What are some problems with medication absorption with the elderly?
- Decreased salivary secretion
- Diminished esophageal motility
- Slowed intestinal motility
- Decreased gastric acid output
- Decreased gastric pH
- Outcome:
- No significant change in quantity absorbed.
- Time to onset or peak may be delayed.
What are some changes with distribution of drugs in the elderly?
- ¨Systemic circulation transports drug through the body
- ¨High blood flow organs receive highest concentration brain, kidney, liver, lungs
- ¨Low blood flow organs receive lowest
- ¨Fat-soluble drugs
- ¨Water-soluble drugs
- ¨Plasma proteins
What are common anticholinergic side effects that occur with older adults?
- Constipation
- Dry mouth
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Why is polypharmacy?
- ¨Use of multiple medications for the same problem
- ¨Very common in older adults
- ¨Can occur intentionally or unintentionally
- ¨Commonly occurs with multiple specialists and lack of communication
- ¨Two major concerns:
- ¡Increased risk for drug interactions
- ¡Increased risk for AE’s
Wht are appropriate and inappropriate examples of polupharmacy?
¨Appropriate
ú All drugs in the regimen address recognized indications
¨ Inappropriate
úMore drugs prescribed than necessary, drugs with unacceptable adverse effects or toxicity prescribed (alone or combined with other drugs), or redundant drugs prescribed
What are some adverse dug reactions from polypharmacy?
- ¨Noxious response to a drug
- ¨Common cause of hospitalization
- ¨Some can be predicted
- ¨Some can’t be predicted
- ¨“Start low, go slow, but go”
- ¨Beer’s list
- ¨ADE
- ¡Report to US Food and Drug Administration
What is the problems with medications and older adults?
A given dose of a given medication produces a different, and sometimes unexpected, response in an elderly patient compared to a younger patient of the same gender and similar body weight.
What are some nursing interventions to reduce adverse drug events in the elderly?
- ¨Give lowest dose possible
- ¨Discontinue unnecessary therapy
- ¨Attempt nondrug approaches first
- ¨Give the safest drug possible
- ¨Assess renal function
- ¨Always consider the risk-to-benefit ratio when adding drugs
- ¨Assess for new interactions with any new prescription
- ¨Avoid the prescribing cascade
- ¨Avoid inappropriate medications
What are the risk factors for adverse drug events?
- More than 6 chronic concurrent illnesses
- More than 12 doses of medications/day
- More than 9 medications
- History of prior drug reaction
- Low body mass index
- Age over 85
- Creatinine clearance less than 50
What are some symptoms of medication-related problems?
- Confusion
- Depression
- Delirium
- Insomnia
- Parkinson’s-like symptoms
- Incontinence
- Weakness or lethargy
- Loss of appetite
- Falls
- Changes in speech
How do you communicate a problem with a medication?
- Situation-Current
- Background-List medications and provide VS’s
- Assessment-I think he/she has…..
- Recommendation-I think he/she needs…..
What is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage…always subjective…a sensation…always unpleasant
What are some differences in pain with the young and old?
Young Adults:
- Clear cause
- Due to acute event
- Treatment based on severity of pain
Older Adults:
- Pain stems from co-morbid conditions
- Persistent
- Multi-dimensional
What are the differnet types of pain?
- Nociceptive – skin, tissue
- Neuropathic – nerve pain
- Mixed or unspecified
- Most common type of pain in late life is chronic
What are some manifestations of chornic pain?
- ¨Depression
- ¨Eating disturbances
- ¨Sleeping disturbances
- ¨Functional impairments
- ¨Confusion
What are some consequences of untreated pain?
- Falls
- Caregiver strain
- Cognitive impairments
- Increased dependency
- Decline in social and recreational activities
- Slowed rehabilitation
What are some barriers to pain managemet?
¨Healthcare Professional Barriers
- Lack of education
- Concern regarding regulatory scrutiny
- Fears of opioid s/e’s and/or addiction
- Belief that it’s a normal part of aging
- Belief that cognitively impaired have less pain
- Own experiences with pain
- Inability to accept self-report without ‘objective’ signs
Patient/Family
- Fear of s/e’s
- Fear of addiction
- Belief pain is normal part of aging
- Belief nothing can be done
- Fear of being a ‘bad’ patient by complaining
What are some nonverbal cues for pain with elders?
- Changes in behavior
- Activities of daily living
- Vocalizations
- Physical changes
How would you conduct a pain assessment with the elderly?
Pain is real
Ask about pain regularly
Isolation
Notice nonverbal pain signs
Evaluate pain characteristics
Does pain impair function?
Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatment previously tried
Describe the different steps of the pain relief ladder
- ALWAYS START WITH Tylenol, up to 4gs a day,
- If that doesn’t work start an NSAID, or ibeprophen, cellbrux
- If pain is moderate and persistent add Vicodin + Tylenol
- IF pain is moderate to severe add another opioid
What are The most common substance use problems/disorders in older adulthood?
- # 1 Nicotine (~18-22%)
- # 2 Alcohol (~2-18%)
- # 3 Psychoactive Prescription Drugs (~2-4%)
- # 4 Other Illegal Drugs (marijuana, cocaine, narcotics) (<1%)
What are some concerns for baby boomers in relation to substance abuse?
- Baby boomers (born 1946 to 1964)
- Have much higher rates of illicit drug use –history of youth drug use
- Generation is larger than earlier cohorts
- First generation indoctrinated with “quick-fix” culture (prescription drugs)
- Subject to same age related physiological, psychological and social changes as other cohorts
What are the consequences of drinking with aging?
Age-related changes make older adults more vulnerable to adverse alcohol effects
- •Higher BAC from a given dose
- •More impairment at a given BAC
Implications for older adult drinkers:
- •Moderate levels of consumption can be more risky
- •More consequences from maintaining consumption
- •Increased consumption may quickly result in consequences
What is the alcohol consumption recommendations for older adults?
NIAAA and CSAT recommend that adults age 65 and older follow these drinking guidelines:
- •No more than 1 drink per day
- •Never more than 2 drinks on any drinking day (binge drinking)
Consistent with patterns shown to have potential health benefits
Limits for older women should be somewhat lower than those for older men
What is abstinence?
no alcohol in previous year
Define low-risk alcohol use
alcohol use within guidelines and not associated with problems
Describe at risk and problem use of alcohol
:alcohol use that has resulted in adverse medical, psychological or social consequences; or substantially increases the likelihood of such problems
What is substance dependence?
medical disorder characterized by loss of control, preoccupation with alcohol, continued use despite problems, physiological symptoms such as tolerance and withdrawal
What are some issues unique to older adults and substance abuse?
- Loss (people, vocation, status)
- Social Isolation and loneliness
- Major financial problems
- Changes in housing
- Family concerns
- Burden of time management
- Complex medical problems
- Multiple medications
- Sensory deficits
- Reduced mobility
- Cognitive impairment or loss
- Impaired self-care
Describe alcohol dependence in older adults
- Rates of alcoholism appear to decline with age
- Drinking patterns that do not meet traditional abuse definitions can lead to higher BAC, chronic illness, poor nutrition and poly-pharmacy in older patients
- Extent of problem difficult to determine due to differences in definitions and lack of age-specific measures
- If past reliance on alcohol to resolve problems exists, then loss of spouse, occupational and role status, and poor social supports can make older adults more vulnerable to misuse
- Less use of illicit drugs
- More unintentional misuse of drugs due to memory loss or misunderstanding of dosing instructions
Describe alcohol misue among older women
- Older women may be at greater risk for alcohol problems due to potential loneliness and depression from outliving spouse, other losses
- Physiologically at greater risk as they age
- Alcohol use recommendations lower than those set for older men and younger women
- Screening and brief intervention useful
How often should older adults be screened for alcohol and prescription drug abuse?
- Every person age 60 and older should be screened for alcohol and prescription drug use/abuse as part of regular physical examination- ‘Brown Bag Approach’
- Screen or re-screen if certain physical symptoms are present or if the older person is undergoing major life changes or transitions
- Ask direct questions about concerns
- Preface questions with link to medical conditions or health concerns
- Do not use stigmatizing terms (e.g. alcoholic)
What is screening?
Application of a test to members of a population for the purpose of estimating their probability of having a specific disorder
Examples:
Cancer, depression, hypertension
What is sensitivity in reference to an instrument?
Measure of instrument’s accuracy in detecting individuals who do have an alcohol problem (True positive/ False negative)
What is specificity in reference to an instrument?
Measuring of instrument’s accuracy in identifying individuals who do not have an alcohol problem (True negative/ False positive)
How would you provide care based on screening results?
Abstinence or Prevention
low-risk drinker message
At-risk drinker or Brief
drug user with other- intervention
wise negative screen
Positive screen for abuse Brief
or dependence assessment
What is a brief intervention and what are the goals of this?
- Definition: Time-limited (5 minutes to 5 brief sessions) and targets a specific health behavior
- Goals:
- a) reduce alcohol consumption
- b) facilitate treatment entry
- Relies on use of screening techniques
- Empirical support of effectiveness for younger and older drinkers
What are Key Components of Alcohol Brief Interventions?
- Screening
- Feedback
- Motivation to change
- Strategies for change
- Negotiated behavioral contract
- Follow-up
What are the 5 stages of the Transtheoretical Model of Behavior Change?
- Precontemplation - Not ready to change
- Contemplation - Plans to change
- Preparation - Prepares an action plan
- Action – Currently making change
- Maintenance – Strives to prevent relapse
What are the steps to motivational interviewing?
R - Roll with Resistance - introduce change strategies
E – Express Empathy – often, accurately, with effective reflection
D – Develop Discrepancy – between patient’s goals and behavior
S – Support Self-Efficacy – express confidence in patient’s abilities
O - Open questions (can’t be answered with yes/no)
A - Affirming (patient’s character/values, things they have done well)
R - Reflecting (“sounds like…” guess at feeling, meaning, affect)
S – Summarize (“what I hear you saying is…and we talked about… and the plan is…”
What are some barriers to seeking alcoholism treatment for older adults?
- Resistance to asking for help
- Disdain of labels (alcoholic, old)
- Lack of transportation
- No significant others to assist in motivation to seek help
- Providers less likely to refer older adults
- Gaps in substance abuse, aging, and mental health services
What are some age-specific treatment elements for the elderly?
- Attention paid to age-related issues (e.g. illness, depression, loss)
- Consistent linkage with medical services
- Staff with geriatric training
- Avoid condescension and respect patient’s views on spirituality, swearing, etc.
- Longer treatment duration, slower pace
- Less confrontation and probing for “private” information
- Accommodate sensory and cognitive declines in educational components
- Groups are especially helpful in reducing shame and improving social network
- Preparation for AA is important due to high level of confrontation
- Less use of self-help jargon
