Final Flashcards
Why is it difficult to define “getting old?”
Subjective, different for everyone
Generally, what are two contrasting outlooks on ageing that may contribute to ageist mindsets?
Positive: Ageing is a good experience, people live longer
Negative: Older individuals considered a “burden”
The stereotypes, prejudice, and discrimination towards oneself or others based on age
Ageism
Among many, what are 4 noted consequences of ageism?
Can erode solidarity between generations
Can devalue or limit our ability to benefit from what older populations can contribute
Can impact our health, longevity and well-being
Far-reaching economic consequences
What are the noted impacts of losing some abilities as you age?
Social impact: Perhaps not as able or willing to socialize, less interaction with others
Intellectual impact: Less able to participate in intellectually stimulating activities
Financial impact: Loss of ability to make an income in the ways in which one used to
Mental/Emotional Impact: Potential to grieve the loss of certain abilities and the lifestyles associated with those abilities in addition to loneliness
What are three ways to combat ageism?
Not getting caught up in narratives and stereotypes
Value the older person for who they are, their experiences, their needs and their wisdom
Do not disregard their feelings or health issues
What 3 factors contributed to the development of retirement?
Developed due to a combination of increased life spans, the growing popularity of pension plans, and government-sponsored benefits
What is a commonly used definition of retirement?
The stage in life when one chooses to leave the workforce and live off sources of income or savings that do not require active work
What is the “set” retirement age in Canada?
65
What is something people who retire often struggle with?
Not feeling like they’re doing something significant/important
What are the 4 phases of retirement?
- Vacation phase
- Loss
- Trial and error
- Reinvention and rewiring
Describe the vacation phase of retirement
Freedom and relaxation
Lasts about a year for most
Describe the loss phase of retirement
Lose a routine, sense of identity, work relationships, purpose, loss of power
Unexpected and difficult
Feelings of fear, anxiety and sometimes depression
3 Ds
What are the three Ds of the loss phase of retirement?
Divorce: Not necessarily in terms of a marriage, but perhaps a divorce from work or regular routines and related psychological impacts
Depression
Decline: Physical and mental
Describe the trial and error phase of retirement.
Search for more meaning in life or a way to contribute
Find things that you love to do and do well
Can be some disappointment and failure involved
Important to keep trying and experiment with different activities
Describe the reinvention and rewiring phase of retirement.
Not everyone makes the transition to this stage
Consider what one’s purpose or mission is
Important to find meaningful activities that provide a sense of accomplishment
Not a question, just remember how important finances are for retirement lol.
N/A
What is a core issue that many elderly individuals have in relation to technology?
It can often be inaccessible and confusing
The use of digital information and communication technologies to access health care services remotely and manage health care
Telehealth
How did Covid-19 impact telehealth services?
Were expanded and used more regularly
What are some suggestions for older adults in terms of technology use?
Participate in training, discuss concerns, explore solutions and be involved
What are some suggestions for healthcare providers in terms of navigating technology use with older patients?
Get training, modify current tools for use with technology, talk with patients about concerns regarding technology use, direct patients to resources
What are some notable limitations to virtual care?
Does not replace in-person visits or ER visits
What does e-shift describe?
An innovative approach to providing of In-Home Community Shift Nursing for end-of-life clients, e-Shift puts a PSW at the bedside that is linked remotely to a RN through the use of smart technology
When cognition is weakened to a point where it impairs a person’s ability to function independently day to day
Dementia
What are the 5 key areas affected by dementia?
Learning and memory, language, visual and spatial, executive functions, social
What signs and symptoms are associated with the learning and memory component of dementia?
Confusion of place and time
Forgetting to take medications, repeating themselves, and forgetting appointments (with no other explanations).
Past memory (for example, from childhood) is easier to recall than more recent memories
Memory loss that disrupts daily life
What signs and symptoms are associated with the language component of dementia?
New problems with words in speaking or writing.
Problems with names, trouble expressing themselves, substituting wrong words, speech may become “choppier”
What signs and symptoms are associated with the visual and spatial components of dementia?
Trouble understanding visual images and spatial relationships.
Trouble driving, getting lost in familiar places.
Shrinkage of the visual field (see what’s in front of them but trouble with peripheral vision)
What signs and symptoms are associated with the executive function components of dementia?
Challenges in planning or solving problems.
Trouble with planning or organizing tasks, problems making complex decisions, challenges with preparing meals or banking
Procedures with multiple steps, even if they are familiar (for example, tying shoes), become difficult
Happens relatively quickly in terms of the progression of dementia
What signs and symptoms are associated with the social components of dementia?
Changes in personality or behaviour, socially inappropriate behaviours, unsafe decisions
What are the two main causes of dementia?
Blood vessel damage
Toxic proteins in the brain
Which type of dementia is associated with blood vessel damage?
Vascular dementia
What are the four types of dementia associated with toxic proteins in the brain?
Alzheimer’s
Parkinson’s disease dementia
Louis Body dementia
Neurodegenerative disorders
What are 7 other causes of cognitive impairment that can often be confused with dementia?
Delirium (UTI, pneumonia)
Alcohol and drug use
Depression
Medications
Concussions or head injuries
Thyroid and abnormal electrolyte imbalances
Vitamin deficiency (B12)
What are some best practices when communicating with people living with dementia?
Talk slowly
Break the conversation into smaller pieces
Use the person’s name
Find other ways to get your message across
What are some best practices when helping a person with dementia with tasks?
Take them away from distractions and noise
Provide guidance or cues
Break bigger tasks into smaller steps
Offer to do a task with them but not for them
What are some ways in which dementia is treated/managed?
No cure for dementia
Possible to treat
How is treating dementia handled?
No cure for dementia
Possible to treat reversible causes
Medications to manage symptoms
What are the five strategies to promote brain health?
Physical activity and weight management
Good diet and nutrition
Blood vessel health
Reducing smoking and alcohol use
Brain and social activity
What is the relationship between developing chronic diseases and age?
The risk of developing chronic diseases and having multiple chronic conditions increases with age
A state of health where the person’s overall well-being and ability to function independently are reduced and vulnerability to deterioration are increased
Frailty
What can the frailty scale be used as an indication for?
Life expectancy and caregiver involvement
Family members, partners, friends or neighbours who provide personal, social, physical, and psychological support to someone in need, without getting paid
Caregiver
What are some strategies for maintaining caregiver wellness?
Eating healthy meals and snacks
Staying active
Adding small activities to each day
Getting adequate sleep
Asking for help
Short-term relief for caregivers provided at home, a healthcare facility or an adult day centre
Respite
How can respite care benefit the person in care?
Providing them with variety, stimulation, and a welcome change of routine
Why is it important for a caregiver to take breaks in terms of impact on caring capacity?
If overwhelmed by the daily grind of caregiving, patience and compassion can wear thin making it harder to connect with or care for the person (compassion fatigue)
The development of patient-centred treatment plans and delivery of care becomes a shared responsibility. The evaluation of treatment options and treatment planning is a collaborative process that involves patients and patients’ families as well
Multidisciplinary care
Practice of caring for patients (and their families) in ways that are meaningful and valuable for the individual
Patient-centred care
For which purpose was interdisciplinary care originally developed?
Care of cancer patients
Who might be included in a multidisciplinary team?
Patient
Family/caregiver
Primary care physician
Care coordinators
Homecare service providers
Community support services
Palliative care team
Hospitals/ER/Clinics
Specialists
The issue that individuals and organizations operate independently of one another, with little support or accountability for continuity of care.
Fragmentation
Services and amenities provided by community-based or institutionally-based health and social service agencies and organizations.
Formal services
What are the two ways in which formal services can be accessed?
In-home or outside the home
What are 7 critical formal services?
Transportation
In-home nursing or personal care services
Home-making or housekeeping services
Home maintenance or chore services
Meals services
Senior centres
Information services
What are three common issues affecting the elderly that make formal services and community care so important?
Mobility issues
Cooking or food issues
Not wanting to move away from home
What are 5 common characteristics of high needs/complex clients?
Unstable medical issues
Frequent hospitalizations and ER visits
Need for personal care, ADL
High risk for placement in LTC
Caregiver Burnout
How can a patient access home care services?
Valid OHIP card
Patient primary care, specialist, family member or caregiver can make a request for an assessment
Community organizations, hospital, ER, or another home care program can make a request for care.
If a secondary or tertiary party makes a request for services, patient consent is required.
What are 5 key aspects of the role of the care coordinator?
Work directly with patients in hospital settings, doctors’ offices, community, schools and in homes.
Establish patient-centered care plans with the goal of maintaining autonomy, keeping the elderly at home for as long as possible.
Assess and determine eligibility for Long Term Care placement, respite services, day programs and home care services for high risk seniors.
Direct and refer to community resources.
Assist in accessing primary care
What are 6 key services available through community and home care?
Care Coordination
Nursing, nutrition, occupational therapy, nutrition, physiotherapy, speech language pathology, social work
Personal Support workers
Medical supplies and equipment, drug cards.
Placement in Long Term Care and respite care.
Specialized services
Drugs that bear a heightened risk of causing significant patient harm when they are used in error
High-alert medications
Team of Registered Nurses that provide care to patients with complex care needs and their families and support smooth and safe transitions from hospital to home
Rapid response nurses (RRNs)
What are 5 key elements of the role of an RRN?
Confirming the patient’s hospital discharge care plan
Initiating communication with the patient’s primary care provider
Reviewing the patient’s medications
Helping the patient and their caregivers to understand the care plan
Identifying individuals requiring accelerated assessment by a Home and Community Care Support Services Care Coordinator
What are the 5 eligibility criteria for the RRN program?
Live at home or in a retirement residence
Have multiple complex medical issues
Have multiple medications or change in medication routine
Have difficulty with disease management
Have a limited support network
Who is the target population for Aging in Place?
At-risk seniors living in social housing, seniors facing access barriers to healthcare
What are 6 services offered by AIP?
Onsite delivery of individual and congregate services and supports
Outreach and Intervention
Health promotion and health education
Nurse Practitioner Primary Care Outreach
Targeted enhanced services
Targeted rapid response
Independent permanent living arrangements for persons with special needs residing as tenants in non-profit social housing settings.
Supportive housing
What are 6 key features of supportive housing?
Permanence and affordability.
Services are multi-disciplinary.
Integration in the community.
Reduces isolation.
Person-centred model.
Services can include counseling, IADL assistance, opportunities for community involvement
What are 4 goals of supportive housing?
Even quality
Universal access
Provision of appropriate choices
Improvement of existing mechanisms in providing housing assistance
Functional abilities including bathing, dressing, getting out of bed, etc
Basic ADLs
Functional abilities including meal preparation, shopping, housework, etc
Basic IADLs
Functional abilities including managing money, using the phone, eating, taking medications, etc
Advanced ADLs
What are the key differences between LTC and retirement homes?
LTC: Government-funded, guaranteed nursing and PSW services, must qualify for admission, waitlist, less costly
Retirement homes: Private, anyone can arrange for admission, usually no waitlist, personal care support not included, cost varies considerably
What are the three key steps to choosing an LTC or retirement home?
Identify needs and wants, gather information and build a list, visit in person
When is a person deemed incapable?
They do not understand and/or appreciate the consequences of their decision
An assessment done in collaboration with the physiotherapist and occupational therapist examining mobility, falls, transfers, assistance with ADLs, need for equipment.
Functional assessment
An assessment done examining a patient’s behaviour and its implications
Behavioural assessment
What are the three core considerations of a capacity assessment?
Ability to understand
Ability to appreciate
Nature of the home and living situation
What happens if a capacity assessment deems someone incapable?
The Power of Attorney (POA) will make the placement decisions on behalf of the person.
If no POA, the family (hierarchy) will make the decisions on the person’s behalf
If no family, the Public Guardian and Trustee can be appointed.
Any adult who depends on others to meet everyday needs because they have a mental illness or developmental disability
Vulnerable adult
Act (or lack of appropriate action) which causes harm or distress to an older person
Elder abuse
What are three main causes of elder abuse?
Having power or control over a senior
Financial/addiction/mental health issues
Caregiver burnout
What are the two main types of elder abuse?
Physical abuse and psychological/emotional abuse
Act of violence causing or intending to cause bodily harm or physical discomfort
Physical abuse
Action or comments instilling fear or emotional anguish
Psychological/emotional abuse
What are three signs of physical elder abuse?
Unexplained injuries
Unusual bruising
“Doctor shopping”
What are three signs of psychological elder abuse?
Fear of certain individuals
Abuser speaking for the senior
Not giving the senior privacy
What is the leading cause of injury among seniors?
Falls
What are 6 common causes of stress for older adults?
Managing chronic illness
Losing a spouse/partner
Being a caregiver
Adjusting to changes due to finances
Retirement
Separation from friends and family
What is the NUTS acronym?
N= Novelty
U= Unpredictable
T= Trending on ego / personality
S= Sense of no control over situation
Intended to allow people the ability to die with dignity when science and medicine can offer no better alternative to alleviate unbearable suffering
MAiD
What are the eligibility criteria to receive MAiD?
Be 18+ and have decision-making capacity
Eligible for publicly-funded healthcare
Voluntary request
Informed consent
Serious and incurable illness
Advanced state of irreversible decline
Enduring and intolerable physical or psychological suffering
Cannot make a request on the basis of health inequities and social issues
An approach that improves the quality of life of
patients and their families who are facing problems associated with a life-threatening illness
Palliative care
What are the goals of palliative care?
Provide comfort, dignity and the best quality of life
What are the 9 principles of symptom management?
Prevention
Assessment
Diagnosis
Goals of care
Managing the underlying cause and/or managing the symptoms
Non-pharm measures/environment
Pharm measures
Education/teaching
Psycho-socio-spiritual dimension
What does the OPQRSTUV acronym stand for?
Onset
Provoking/alleviating
Quality
Region/radiation
Severity
Treatment
Understanding/impact on you
Values
What does the SPIKES acronym stand for?
Setting
Patient’s perception
Invitation
Knowledge
Exploring/empathy
Strategy/summary
A process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.
Advance care planning
The overarching aims of medical care for a patient that are informed by patients’ underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation on specific medical interventions.
Goals of care (GOC)
A designated person authorized to make decisions on behalf of a patient who is unable to make important decisions about their own personal care
Substitute decision maker
A legal document that gives someone you trust the right to make financial or health care decisions for you
Power of Attorney (POA)
What are 5 signs death is approaching?
Profound weakness and fatigue, bedbound
Total care with ADLs
Significantly decreased appetite and PO intake
Difficulties swallowing meds
Somnolence, reduced cognition, sleeping more
What are 5 signs death is imminent?
Altered breathing (Cheyne-Stoke breathing)
Decreased consciousness
Cold and mottling extremities
Upper airway secretions
Decreased urine output
Applying to a mentally incapable person and encompassing financial and personal care decisions
Substitute decisions act (SDA)
Applies when a person is incapable of making a decision in the management of their property
or when a person is unable to appreciate the reasonably foreseeable consequences of a decision or lack of decision
Power of Attorney for Property
What are the differences between an SDM and a POA?
SDM:
SDM
1. HCCA
2. A person who has been designated to make
decisions on your behalf if you are not able to make them yourself
3. Can be Court appointed
4. Can be the Public Trustee / Guardian
POA:
1. SDA
2. A person appointed to make decisions for an incapable person
3. Appointed by an executed Power of Attorney
According to the SDA, a person is incapable of making personal care decisions if…
The person is unable to understand information relevant to their own health care, nutrition, shelter, clothing, hygiene, or safety
The person is unable to appreciate the reasonably foreseeable consequences of a decision
Under the HCCA, which steps must be considered to determine if consent if required?
- Determining capacity
- Consent must relate to specific treatment
What can’t an Attorney for Personal care consent to?
Treatments that are prohibited
Confinement, monitoring devices, drug or physical retrains
