Geriatric Nursing

Question 1

5 Geriatric Syndromes (DIFFP)

Answer 1

1. Delirium, dementia, depression
2. Incontinence
3. Falls
4. Functional decline
5. Pressure ulcers

Question 2

Other Geriatric Syndromes

Answer 2

a. Nutrition and weight loss
b. sarcopenia
c. dizziness and syncope

Question 3

Ageism

Answer 3

“deep and profound prejudice against the elderly which is found to some degree in all of us..results in older persons being categorized as senile, rigid, and old-fashioned in morality and skills”

Question 4

“Bed blockers”

Answer 4

older adults in acute care beds waiting for long term care - framed as blocking the bed for someone who needs it more

Question 5

“GOMER”

Answer 5

Get out of my ER

Question 6

Elderspeak

Answer 6

speaking to elder like children, patronizing tone

Question 7

Non-specific diagnoses

Answer 7

“failure to cope/thrive”

Doesn’t mean anything about care
Seems to blame patient..who’s failure is it?

Question 8

Consequences of Ageism

Answer 8

a. less likely to be referred to surgery
b. less willing to implement therapeutic strategies to help suicidal OAs
c. using wrong demographic assessments
d. the more negative the nurses’ attitudes, the shorter and more task-oriented their conversations

Question 9

Syncope

Answer 9

temporary loss of consciousness due to lack of blood flow to the brain

Question 10

Geriatric Syndromes

Answer 10

• a category of diagnoses
• multiple underlying factors involving multiple organ systems
• associated with substantial morbidity and poor outcomes, impact quality of life and disability

“multifactorial health conditions that occur when accumulated effects of impairments in multiple systems render person vulnerable to situational challenges”

Question 11

Shared risk factors

Answer 11

• older age
• cognitive impairment
• functional impairment
• impaired mobility
• poor nutritional status
• female gender
• depressive symptoms

All shared risk factors can lead to frailty, a hallmark of geriatric syndromes

frailty causes GS, or GS causes frailty

Question 12

Multifactorial Complexity

Answer 12

models for targeting pathophysiological relevant mechanism

a. linear (risk > early disease > advanced disease)
- does not capture complexity of GS

b. concentric
- intervention targeting one risk factor only addresses small portion of overall risk

c. interactive concentric
- risk factor synergism, design of interventions to target multiple risk factors

Question 13

Presbycusis

Answer 13

sensorineural hearing loss; degeneration of hair cells in the cochlea and otic nerve loss (inner ear) resulting in impaired transmission of sound waves to wave

Risk factors: aging, exposure to loud noice, caucasian, ear structure damage

Question 14

Impact of hearing loss

Answer 14

a. reduced quality of life of affected person
b. impeded self-care, loss of independence (OAs)
c. increased burden of communication, poorer relationship satisfaction (caregiver)
d. reduced speech understanding and ability to engage in society (society)

Question 15

Relevance of hearing loss on cognition

Answer 15

sensory impairments increase risk for costly health outcomes

Age Related Hearing Loss associated with poorer cognitive functioning and incident dementia

• effect on cortical processing
• increased cognitive load
• social isolation

Strong link between hearing loss and loss of cognition

Question 16

Hearing interventions

Answer 16

a. pocket talker (microphone)
b. hearing aids
c. cochlear implant surgery (only for profoundly deaf)

d. text message phone with closed captioning
e. Formal hearing assessment (Weber test, Rinne test)
f. community-based interventions are needed (integrate technologies)

Question 17

Visual Impairment (Dev considerations)

Answer 17

a. extraocular - lower lid can turn inward/outward leading to dry eyes
b. ocular changes - glaucoma, light fractures, external glare, colour perception reduced
c. intraocular - less rods leading to reduced peripheral vision and colour clarity

Question 18

Impact of vision impairment

Answer 18

a. reduced quality of life

b. increased chance of mortality and institutionalization

Question 19

Vision interventions

Answer 19

a. glasses
b. technological devices (talking clocks and read out loud devices)
c. audiobooks and podcasts
d. magnifying glasses
e. cutlery that is bright red/orange
f. adequate lighting in the room

Question 20

Dual sensory loss

Answer 20

Combination loss of hearing and sight

Impact:

a. further challenges cognitive functioning
b. poorer quality of life
c. increased depression
d. increase mortality risk

Question 21

Communication with older adults

Answer 21

Influenced by their life experience, what the norm was at their time when they were younger

• use person-centred care
• “they are who they have always been”

Question 22

Generational power

Answer 22

a. older adults (>65)
- influenced by austerity
- war
- respect for authority, pride in being responsible, cautious, family-oriented

b. baby boomers (50-64)
- less trusting of authority
- like to have control, equality, advocacy, sandwich generation taking care of parents and children

c. gen x (<50)

Question 23

Clinical Communication Strategies

Answer 23

1. Ask permission
   - shows they have a voice and choice, hand over control
2. Show you care
   - person-oriented, what they value
3. Work together
4. Agree on next steps
   - mutual understanding

Question 24

Strategies for Effective Communication

Answer 24

Hearing

a. do not shout
b. do not assume hearing loss
c. inappropriate responses, inattentiveness may be signs of hearing loss
d. gain individual’s attention before you speak
e. determine if hearing is better in one ear and position accordingly

Vision

a. make sure you have person’s attention before you speak
b. get down to person’s eye level and face them when speaking
c. speak normally
d. do not rearrange room or personal items without permission
e. speak promptly, state who you are and when you are leaving

Cognitive impairment

a. one-step instructions
b. speak slowly
c. allow time for response
d. reduce distractions
e. one person at a time