Gero Exam 2 Flashcards
Xerosis
Dry, cracked, itchy skin. Inadequate fluid intake worsens disease. Use super-fatted soaps or cleansers.
- One of the most common skin issues in older adults
- Primarily on extremities, but can happen on face or trunk (will see flakey skin falling off in bed sheets)
Pruritus
Itchy skin. A symptom not a diagnosis. May be r/t med side effects or secondary to disease. A threat to skin integrity.
- Ex: symptom of xerosis
- Red skin color to it; Skin starts to breakdown and fall apart = more irritation
Purpura
Thin, fragile skin – extravasation of blood into surrounding tissue. Wear long sleeves & protect from trauma.
- Dorsal forearm and dorsal side of skin and on hand
- More common in pts with blood thinners (when they bump into things)
- Occurs in fair skinned people often
- Often seen with normal aging (older = worse)
Actinic keratosis
Precancerous skin lesion. From sun exposure. Dermatology visits every 6-12 months to monitor & treat.
- Overuse of UV lights (tanning beds)
- Topical chemo in some cases or medically removed
Seborrheic keratosis
Waxy, raised, “stuck-on” appearance, benign lesion. Almost ALL older adults over 65 y/o.
- Can be removed by dermatologist if needed
- if you hear patients say “I had a skin tag”
Herpes zoster
Painful, vesicular rash, over a dermatome. Get vaccine at age 60.
- Dermatome = nerve pathway of body
- On upper back/torso and is very painful (more painful before rash appears)
- If they have chicken pox then they will have these
- Scratch, then blisters, once blisters open then = very contagious (pregnant women cannot take care of these patients); must gown and glove up very well
- You should not take care of them if you have never had chickenpox
- Medicate properly: pain meds — ointment or local patch (near area, not directly on rash); itching = antihistamine or benadryl
Candidiasis
Yeast infection, often in skin folds. Keep skin clean and dry.
- obese/malnutrition = increased risk
- Diabetic patients due to impaired wound healing
- Found in warm, moist, dark places (skin folds, under boobs, in groin)
- Thrush in the mouth is called candidiasis (white cakey covering on the tongue)
Pressure Injury Highest Incidence reported in
*Hospitalized or institutionalized older adults
*Vulnerable adults undergoing orthopedic procedures
Pressure Injury
*Can significantly impair recovery/rehabilitation & impact QOL
*Increased risk of mortality
*High prevalence of healthcare litigation - Pressure injuries cause lawsuits
*Centers for Medicare and Medicaid (CMS) now consider pressure ulcers a preventable adverse event and do NOT reimburse treatment for pressure ulcers acquired during admission
- Most pressure injuries are preventable (except amputees with prosthetics, imobile, medical devices used improperly)
- take protheses off frequently and check stump and area around and tell patients to take them of periodically to prevent injury and infection and check for pressure sore
- turn patients often
- Hospital is responsible for cost if patient gets a pressure injury while in their care
Stage One Pressure Ulcer
Skin is unbroken, but inflamed
Stage Two Pressure Ulcer
Skin is broken to epidermis or dermis
Stage 3 Pressure Ulcer
Ulcer extends to subcutaneous fat layer
Stage 4 Pressure Ulcer
Ulcer extends to muscle or bone; undermining is likely
- stage 4 can also have tunneling
Unstageable
Injury is covered by slough or eschar
Deep Tissue Injury
- deep tissue injury (bruise) can turn into a stage one in older adults because they do not heal as quickly anymore
Adequate nutrition
key factor in maintaining health
Adequate diet
important factor in delaying onset & managing chronic illness
MNA
Mini-nutritional Assessment Tool
- Assesses for malnutrition
- shows what they are getting and what they are missing so we can educate them
Proper nutrition includes all the essential nutrients
o Carbohydrates – 45-65%
o Fat – 20-35%
o Protein – 10-35%
o Vitamins & Minerals – 5 servings of fruit & veggies
Myplate For Older Adults
- Important Nutrients: potassium, calcium, vitamin B12, vitamin D, dietary fiber
- Stay active 60 minutes each day
- Choose bright colored vegetables
- Make half your plate fruits and vegetables
- Make at least half your grains whole grains
- Vary your protein food choices
- Drink plenty of fluids: water, 100% juice, Low-fat/fat-free/low-lactose milk
- make sure pts are properly preparing food: chilling food and not cross contamination with raw meats (at risk for E. coli)
- making sure they are getting enough protein for muscle mass
Obesity and Older Adults
o Recent sharp rise in obese or overweight older adults - 82% increase in obese elderly
o ¹∕₃ of 65+ are obese (mainly women)
o Overweight/Obesity is dangerous in younger
Obesity paradox
Obesity may be protective in older, >70
- mortality is lower for overweight BMI (less osteoporosis)
- Obesity can protect you from OP if you get it later in life
Healthy weight throughout life is intervention best supported by the evidence
- Obesity is linked to health problems like HTN and DM
BMI classifications for overweight, obese, morbid obese
overweight (> 25)
obese (>30)
morbid obese (35-49)
Malnutrition
- malnutrition is too much or too little protein, energy, or nutrients that has adverse effects on the body that affects the function and clinical outcome of your patient
*A geriatric syndrome
*Rising incidence in acute care, long-term care, and in the community - because they are not eating what they want to eat (they are served what the home gives); may need to supplement with boost/ensure or have family bring in food
- Take your time when feeding patients, do not rush patients, do not put too much on the spoon
*Institutionalized older adults at high risk for malnutrition due to chronic disease and functional impairments
*Increased risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition and increased morbidity and mortality
*Comprehensive screening and assessment is critical to identify older adults at risk
Malnutrition RIsk Factors
- age related change in taste or smell
- oral health status (do they have their dentures)
- chronic diseases and the side effects of medications
- lifelong eating habits (integrate what they like and do not like)
- socialization (some people are loners so they just buy snack foods or things for sandwiches = suggest steamable vegetables)
- income impacts them buying proper food (they shop on a budget so they choose cheaper items that are packaged or canned)
- 40-60% of elderly in long term care patients are malnutritioned (often due to the diets we give them - figure out what they like and do not like)
Dysphagia
*Difficulty swallowing (dysphagia)
- Just because they have dysphagia, does not mean they cannot eat
*About 20% of those over 50
*Up to 60% of LTC residents (have dysphagia)
- Labored swallowing = slow to swallow
- Coughing/choking = sit up patients (make sure they can clear secretions)
- Increased oral secretions makes patients nervous to swallow so it builds up in their mouth — Make sure they swallow saliva (they are afraid to swallow because salvia is thin)
- Make sure they have not pocketed food in their cheek
- Make sure they have no chest pain due to acid reflux (position patient properly)
Dysphagia: Prevention of Aspiration
*Supervise all meals
*Seated and rested before eating
*Sitting up at 90 degrees
*Don’t rush meals
*Alternate solids and liquids
*Chin-tuck swallow
*Thickened liquids and pureed foods
- Thickened food for patients = easier to swallow
- Thicken liquids if needed (some come already thickened) and see if they need a puree diet
*Avoid sedatives (ativan or benadryl) – may impair cough reflex
- and makes them sleepy; if they have to have medications try to feed them before
*Keep suction readily available
*Oral care
- most patients want their teeth cleaned before they eat (helps them to eat because they can taste)
- Do proper oral care and make sure they do not have pain in their throat or mouth
PEG Tubes in Advanced Dementia Myths
*Prevent death from inadequate intake
*Reduce aspiration pneumonia
- they still might have oral liquids or food
*Improve nutritional status
*Provide comfort at end-of-life
PEG Tubes in Advanced Dementia Facts
*Do not improve QOL (quality of life)
- just gives proper nutrients needed
*Do not prolong survival in dementia
*Associated with increased agitation, use of restraints, & worsening pressure injuries
*50% of patients die within 6 months of insertion
*Are associated with infection, GI symptoms and abscesses
*Are popular r/t convenience & labor costs
Hydration
Adequate fluid consumption & maintenance of fluid balance essential to health
Risk factors for changes in fluid balance
o Physiological changes in body water content
o Impaired thirst sensation
o Medications
- At high risk for dry mouth/dehydration: medications [anticholinergics, antidepressants, MAOBs for antiparkinson, antihistamines (benadryl or zyrtec), antihypertensive (enderlol), diuretics (lasix), antispasmodics which is a muscle relaxer (zanaflex)]
o Functional impairments
- impaired movement
o Chronic illness
- HIV positive pts, diabetes, hep C
o Emotional illness
o High environmental temperatures
- temperature outside
Reasons why dehydration risk increases with age
o Water/body ratio decreases, making you more susceptible to dehydration
o Requiring the need of daily care as we are less able to handle day-to-day tasks
o Needing assistance with food and fluids can significantly reduce self-hydration
o Increased incontinence results in the need to replenish our fluids more often
o Cognitive impairment can mean that we may forget to keep ourselves hydrated
o With increased age brings a diminished thirst sense
o The need for multiple medications can increase the onset of dehydration
o Increase likelihood of acute illnesses, can result in our body being dehydrated
Solutions:
- put liquids in front of patients and remind them to drink (some might not even remember they did not drink all day) especially with incontinence patients
- they will decrease drinking because they do not want to have to go to the restroom as often
Dehydration Categories: Can Drink
o Able to drink - they might just not want to drink
o May not know what’s adequate
o Possible cog impairment
o Encourage & make fluids accessible
Dehydration Categories: Can’t Drink
o Physical incapable to ingesting or accessing fluids
o Dysphagia prevention
o Swallow evaluation
o Safe drinking techniques
Dehydration Categories: Won’t Drink
o Highest risk for dehydration
o Able to drink but refuses
o Offer frequently
o Prevent incontinence
End of Life
o Terminally ill
o Could be any of previous 3 (Can, Can’t, or Won’t drink)
o Refer to advanced directives with regard to hydration wishes
Signs of Dehydration
*Skin turgor (unreliable r/t skin changes)
*Weight
*Mucous membranes
*Speech changes
*Tachycardia
*Decreased UOP
*Dark urine
*Weakness
*Dry axilla
*Sunken eyes
o Many of these signs are often unreliable in older people. Look at big picture. Dehydration generally confirmed with lab testing.
- look at patient first (lab tests will give definitive answer if the patient is dehydrated)
How much should the gero population drink per day?
At least 1500 mL/day (1.5 Liters or more)
Interventions - Hydration
*At least 1500 mL/day (1.5 Liters or more)
*Fluid quality - Water is BEST
*Offer often
- offer fluids more often that food (fluids are more important than food)
*Make readily available
- cup poured on the nightstand (keep fluids within reach)
*Encourage with meds
- encourage them to drink the whole drink with it
*Provide preferred fluids
- Stay away from carbonation
- Dairy free or lactose free (soy based is a good option)
- 100% juice if you cannot get them to drink
- If they want coke “If you drink the same amount of water then I will give you a coke”
- Watch them drink to make sure they are drinking
*Verbal reminders
Urge Incontinence
Loss of moderate to large amount of urine before getting to the toilet; inability to suppress urge to urinate
- when you have been holding it too long (fall hazard if they have to rush to the bathroom)
Stress Incontinence
Loss of small amount of urine with activities that increase intra abdominal pressure (coughing, sneezing, exercising, lifting, bending)
- more common in women, but can occur in men after prostate surgery
Functional Incontinence
Lower urinary tract intact, but individual unable to reach toilet due to environmental barriers, physical limitations, cognitive impairment, lack of assistance, difficulty managing belts/zippers/getting a dress up and down/getting undergarments down, or sitting on a toilet
Incontinence Interventions
*Scheduled & Prompted voiding
- put them on a schedule every 2 hours (we always have a reserve in the bladder even if they think they do not need to go)
*Pelvic floor muscle exercises (Kegels)
*Thorough assessment of continence
- when did this start? Is it related to anything? (meds, cognitive function, surgery, life changes)
*Lifestyle Modifications
- discrete briefs; some patients prefer pull-ups rather than diapers
*Medications
- anticholinergics or antimuscarinics
*Urinary catheters – last resort
- because risk of UTI (internal)
- Condom catheters (they will say large, but they need a small; make sure that you grab the shaft firmly and use adhesive because acid in urine breaks down adhesive)
- Purewick (make sure they actually need it because it vibrates and sometimes they just want action); make sure inner thigh and outer thigh is not getting irritates (may need towel in between)
- Change every 8 hrs for external catheters
Urinary Tract Infection
o Most common cause of sepsis in older adults
- First urine from foley we send to lab to make sure it was clear and then if there’s an infection we remove foley, put on antibiotics, and insert again and make sure it is sterile
o Often asymptomatic
o Cognitively impaired may not report symptoms
o Atypical Symptoms: Mental status change (#1 sign in older adults with or without a foley), Decreased appetite, and Incontinence
o Normal for older adults to have asymptomatic, uncomplicated bacteria in urine.
- Tell them to not hold urine if they need to urinate (retaining urine is not good)
Constipation
o Reduction in bowel movement frequency or difficulty in forming or passing of stool
o 40% of older experience constipation: More common in women
- due to extra organs in abdominal area
- make sure to auscultate for bowel sounds and determine why if abnormal (lack of fiber or meds)
- they will get distended and not want to eat or do anything
Constipation Complications
o Impaction, obstruction, cognitive dysfunction, delirium, falls, increased morbidity & mortality
o Increased risk for bowel cancer
Constipation - Interventions
Increase physical activity
*Increases motility (walk with the patient)
Proper positioning
*Squatting, leaning forward (physiology)
- Have patients sit up for 30 minutes first to prevent swallowing or dysphagia issues, then lay patient on their left side, and then when their stomach starts cramping sit them on the toilet
Toileting regimen
*Normalizes bowel function
*Attempt BM after breakfast or dinner (gastrocolic reflex)
*Allow at least 10 minutes for BM
- do not rush them (you have to stand there with them)
Increase dietary fiber
*Know foods high in fiber
- wheat, green leafy, dry fruit, dry beans, vegetables, bran, cereal, bananas, peas, lentils, leafy greens, pear, avocado, raspberries, almonds, cooked black beans, air-popped popcorn, cooked pearled barley
- Patients who are in bed who have a high fiber diet can cause skin breakdown if they are immobile
Increase fluid intake – at least 1.5L per day
Constipation Pharmacotherapy
o Bulk-forming (fiber) - psyllium (Metamucil)
o Emollients – docusate sodium
o Osmotic - polyethylene glycol (PEG), milk of magnesia, lactulose
o Stimulant – bisacodyl, senna
Enemas
o Last resort
o Don’t use on regular basis
o May alter fluid and electrolyte status
o Sodium phosphate enemas contraindicated in older
- Have used syrup as enema (anything slippery)
Fecal Impaction - Complication of constipation
*Common in incapacitated and those in institutions
o Increased incidence with narcotics
- Dualadid, morphine, percocet, lortab
- slows GI system down
*Manifestations & complications
o Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids (occurs from bearing down trying to have a BM - inside of rectum and can be prolapsed onto the outside), intestinal obstruction.
Fecal Impaction Nursing management
*First prevent!
*Removal of impaction
- nurses do not disimpact patients (MDs are responsible because we are messing with the vagus nerve); can take several days for it to all come out and sometimes have to have surgery to have it removed
o Digital removal of hard stool from rectum
o Use copious lubricant
o May take several days
o Don’t dis-impact too much
o Often very painful
Sleep Stages
*NREM (75% of night)
o Stage 1-4
*REM (25% of night)
- most important part of sleep
Age-Related Sleep Changes In Sleep Stages
*Most changes in sleep begin >50 y/o
*Less time in Stage 3-4
o Stage 3-4 = Feeling rested and refreshed
*More time awake or Stage 1
*REM critical for elders – brain replenishment
- Instruct patients to wait to go to sleep until the sun goes down (make sure naps are not deep sleep); if they sleep too much during the day it can cause confusion between night and day
Sleep
*Barometer for health
*Aging associated with:
o Decreased sleep efficiency & total time
o Sleep disorders
- sun downers - turn all lights on and close shades before it gets dark to avoid cognitive impairment
o Circadian rhythm responses diminished
o Increase in stage one of sleep – less REM
o Longer to fall asleep
o Frequent awakenings
o Increased napping during day
o Frequency of leg movement increased
*Must assess sleep patterns! – Poor sleep is NOT inevitable but indicator of health status
*Older need just as much sleep as younger
- sometimes it is their medications making them sleep, not their bodies telling them to sleep; many older adults do not sleep as much as we do
*Pittsburgh Sleep Quality Index - assessment tool
Sleep & Aging
Biorhythm and sleep
o Age related changes in the body’s perception of light-dark cycle and circadian sleep-wake rhythm
Sleep Cycle
o Changes in sleep cycle that reduce amount of deep sleep and time spent in REM sleep
*Sleep deprivation and fragmented sleep can adversely affect cognitive, emotional, and physical functioning as well as quality of life
Insomnia
*Disturbed sleep in the presence of adequate opportunities and circumstances
*Medications and substance - Causes
o Drugs and ETOH (10-15% of insomnia)
- alcohol can cause them to wake up due to AE of ETOH (throwing up, having to urinate, headaches)
*Eliminate underlying cause if possible
- Cluster medications so they we do not have to wake them up as often (teach them to do the same thing at home)
Insomnia is a DIAGNOSIS
o Difficulty falling asleep >1 month
- “I have to count sheep to fall asleep”
o AND impairment in daytime functioning r/t poor sleep
o Primary (just have it bc you have it) vs. comorbid (other problem that lead to insomnia like HTN, diabetes, drugs)
Sleep Teaching
*Maximize comfort
*Bedroom is for two things – both start with S (sex and sleep)
*Avoid or limit naps < 2 hours
*Exercise (not before bedtime) and outdoor time
*Bedtime routine
*Limit tobacco, caffeine and ETOH – in evening
- try to get them to smoke during the day and not at night if they will not quit
*Manage GERD
- make sure they stay up 30-45 minutes after they eat
*Avoid screen time just before bed
- 30 minutes before bed
*If can’t fall asleep
o Go to another room until feeling sleepy
Sleep Meds – No good answer
*Older should avoid sleep aids, in general
- some people get addicted and some do not work at all in elderly
o Especially Benzodiazepines
*OTC medications
o Diphenhydramine (benadryl)
*Preferred Sleep RX – benzodiazepine receptor agonist (zolpidem) or melatonin receptor agonist (ramelteon)
o Lowest dose (start at ½ dose)
o Short-term
o Zolpidem – High ED visits for adverse drug events
*Always remember SAFETY
- Ambien can cause adverse effects (can make you wide awake)
Sleep Apnea
*Periods of no breathing while sleeping
S/S:
o Excessive daytime sleepiness
o Snoring, gasping, choking
- often people who snore do not know they have sleep apnea
o Headache, irritability
o Symptoms often blamed on age!
*Assess with Epworth Sleepiness Scale
Obstructive Sleep Apnea
*70% of men; 56% of women > 65 y/o
o Cause: Decline in tone of upper airway muscles
*Linked to: heart failure, cardiac dysrhythmias, stroke, T2DM, OP & death
*Limit/stop ETOH & sedatives, weight loss, smoking, CPAP
- When they have to get on a CPAP machine there are different options for claustrophobic patients
Physical activity – What & How Much
*2.5 hours weekly of moderate aerobic
- ex: swimming pools for aerobics in LTC
*Muscle strengthening activities at least 2 days per week
o All major muscle groups
- key to keep patients mobile and decrease fall risk
Mod intensity aerobic
Continuous movement involving large muscle groups that is sustained for a minimum of 10 minutes; should make your heart beat faster
Ex: Biking, swimming and other water based activities, dancing, brisk walking, lifestyle activities that incorporate large muscle groups (pushing a lawn mower, climbing stairs)
Muscle-strengthening
Activities that involve moving or lifting some type of resistance and work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms)
Ex: Lifting weights, calisthenics, working with resistance bands, pilates, exercises that use the body’s own weight for resistance (push-ups, sit-ups), heavy gardening (digging, shoveling), washing windows or floors
Stretching
(flexibility) a therapeutic maneuver designed to elongate shortened soft tissue structures and increase flexibility
Ex: yoga, ROM exercises
Balance
Movements that improve the ability to maintain control of the body over the base of support to avoid falling
Ex: Tai chi, exercises such as standing on one foot, walking heel to toe or backward or sideways, leg raises, hip extensions (can be done holding on to a chair), standing up from a sitting position without using your hands
Physical activity (Exercise) - Safety
*Know the NO’s
*Don’t exercise when:
o SBP (systolic BP) > 200 mm Hg
o DBP (diastolic BP) > 100 mm Hg
o Resting HR > 120 bpm
o For 2 hrs after a big meal
- to avoid cramping in abdomen and legs (can cause safety issues)
Feet: Age-related changes
*Skin becomes drier, less elastic, cooler
*Subcutaneous tissue on dorsum and sides of foot thins
*Plantar fat pad shrinks and degenerates
*Toenails become brittle, thicken, less resistant to fungal infections
- cut toenails straight across
*Degenerative joint disease decreases range of motion
- Assess pads of feet, in between toes, and nails for discoloration and capillary refill
- teach diabetic patients to check (or family/caregiver) due to loss of nerve feeling in feet
Corns/calluses
Thick, compacted skin often from prolonged pressure. Pad and protect area is BEST. Proper fitting shoes.
Bunions
Bony deformities – great toe or fifth toe from chronic squeezing or hereditary. Custom shoes, surgery, or steroid injection.
Hammer toe
Permanently flexed toe (clawlike). Custom shoes or surgery.
- Common in older white population
Onchomycosis
Yellow, brown, opaque, brittle and thick nails. Difficult to treat – costly & limited effectiveness.
Proper foot care
*If DM - Must have annual foot exam by healthcare provider (podiatrist)
- some may need to go more often
*Care of toenails
o Best cut after bath or soaking 20-30 min – softens nails
- Check water with elbow (closest to diabetic feet feeling) for proper temperature
o Clip straight across
*Proper fitting footwear (orthotic shoe is paid for by medicare, wide or narrow shoes)
*Orthotic shoes as needed (medicare and medicaid will pay for them)
Falls
*Geriatric Syndrome: (malnutrition)
o ¹∕₃ over 65 y/o fall each year
o 10% sustain serious injury
*Falls are a SYMPTOM of a problem
*Consequences of Falls
o Hip fractures
o Traumatic brain injury
o Fallophobia — Fear of falling causing limitations in function
- catch them and let them slide down you because you are less susceptible to injury than them
- sentinel event when there are falls in the hospital (patient changes from one status to another) and sometimes you have to go to court for it to figure out if it could’ve been prevented
Fall Risk Assessment
Assessment Tools
o Hendrich II Fall Risk Model
o Morse Fall Scale
Major risk factors
o Orthostatic hypotension
o Cognitive impairment
o Impaired vision and hearing
o Medications
o Environmental factors
o Weakness and frailty
- assess risk for falls in ALL patients
Fall prevention interventions
Fall risk reduction programs
*Fall bundles
o Arm bands (“fall risk” bracelet), signs, education, risk assessment, footwear (make sure it is non-skid socks or non-skid shoes), assisted toileting
*Environmental modifications
*Assistive devices
- educate on how to use and have them within reach (walkers/canes)
*Safe client handling
*Wheelchairs
- most slide or roll out of wheelchair
*Alarms/motion sensors
- always determine where the alarm is going off
Restraints & Side Rails
*Device to limit movement to prevent harm
- Wanderguard (ankle bracelets) that sets off alarm if they walk past a certain area (sometimes put on wrist if it does not fit ankle)
*Consequences of restraints in older adults
o Do not effectively prevent falls, wandering, or removing medical equipment
o Probably exacerbate the problem
o Restrain-related death: Asphyxiation
o Pressure ulcers, agitation, cognitive decline, depression
- Check for pressure ulcers in restraints
Restraints & Side Rails
*Not simply a part of the bed
*Type of restraint (four side rails up is a form of restraint — you can have 2 or 3 side rails up)
o If two full length or four half length up (four side rails is a form of restraint and can increase fall risk)
- If in arm or ankle restraints (2 point or 4 point) you need to monitor and check underneath and have to take them off to assess — make sure they can go to the bathroom, exercise, get something to drink, etc
- Give them an activity to do (folding towels or folding paper) to be able to keep them out of restraints
*Research evidence does not show side rails reduce falls or injury
*Some evidence that they increase injuries!
*Centers for Medicare and Medicaid (CMS)
o Require documentation of need for side rails
- Document all restraints (if you have all 4 side rails up you need to document WHY)
- Document on time; they often need a 1 to 1 sitter (PCA or nurse will have to be pulled out of staffing)
- Rarely use vests in the hospital because they can cause strangulation
- Violent patients in restraints = document every 15 minutes
- Regular patients in restraints = document every 30 min-hour
Restraint-Free Care
*The goal for care in the older especially
*Should not be used to manage behavior symptoms
- Used for when there is a safety problem (pulling out IV)
*Treat underlying problem
*Practice with the evidence!
Acute Illness
*Occurs suddenly and often without warning
*Stroke, myocardial infarction (heart attack), hip fracture, infection (can fix and get rid of)
Chronic Illness
*Managed rather than cured
*Always present but not always visible - can be at bay
*Most common chronic condition in persons over 65 is arthritis, followed by hypertension
10 Common Chronic Conditions in Adults Over 65
1) Hypertension 58%
2) High Cholesterol 47%
3) Arthritis 31%
4) Ischemic Heart Disease (or CAD) 29%
5) Diabetes 27%
6) Chronic Kidney Disease 18%
7) Heart Failure 14%
8) Depression 14%
9) Alzheimer’s Disease and Dementia 11%
10) Chronic Obstructive Pulmonary Disease 11%
80% have at least 1 chronic condition
68% have 2 or more chronic conditions
Chronic Illness Trajectory: Preventive phase (pre-trajectory)
No S/Sx (no signs and symptoms)
Chronic Illness Trajectory: Definitive phase (trajectory onset)
S/Sx & diagnosis PRESENT
- trying to see if we can make it go away
Chronic Illness Trajectory: Crisis phase
Life-threatening situation
- not just treating the symptoms, but treating the disease
Chronic Illness Trajectory: Acute phase
Active illness requiring hospitalization
- many pts in the hospitals are in this phase
