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Gero > Gerontology Lecture II > Flashcards

Gerontology Lecture II Flashcards

Exam 1

1
Q

Characteristics of Illness in Older Adults

Presence of many interacting conditions and factors such as:

A

Acute illness

Chronic conditions

Psychosocial factors

Environmental conditions

Age-related changes

Medication effects

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2
Q

Comorbidity and the older adultchapter 28-pages 562-564

What is comorbidities?

A

having more than one illness at the same time (e.g., diabetes, congestive heart failure)

This term is used when a patient has one primary condition and additional conditions that coexist with the primary disease.

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3
Q

Comorbidity and the older adultchapter 28-pages 562-564

What does comorbidities focus on?

A

Comorbidity focuses on the relationship of additional diseases with a primary condition.

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4
Q

What is an example of comorbidities?

A

For example, if a person is diagnosed with diabetes (primary condition) and also has hypertension and depression, the latter two are considered comorbidities.

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5
Q

Multimorbidity:

A

combination of chronic (e.g., diabetes, congestive heart failure) and acute conditions ( infection/injury).

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6
Q

What is an example of multimorbidity?

A

A patient with diabetes, arthritis, and heart disease would be classified as having multimorbidity because all these conditions are chronic and equally affect the patient’s health.

There is no one chronic “primary” condition; all are managed together with an acute condition.

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7
Q

What accounts for the majority of healthcare needs?

A

Chronic conditions account for the majority of health care needs of older adults, and these conditions have a significant effect on quality of life and a tremendous impact on psychosocial function in older adults

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8
Q

Frailty

A

multisystem decline that increases vulnerability to poor health effects

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9
Q

What is the definition of frailty?

A

Frail is used to describe an older person who experiences progressive physiological decline, often accompanied by chronic disease, unintentional weight loss of more than 5% of body weight, social isolation, recurrent acute illness, and functional and/or cognitive decline.

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10
Q

Frailty-clinical manifestations

Clinical manifestations of frailty (include 3 or more)

A

Unintentional weight loss

Self-reported exhaustion

Weakness-diminished handgrip strength

Slow walking speed

Low level of physical activity

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11
Q

Three Pathways Leading to Frailty

A

Physical Dimension:

Social Dimension:

Psychological Dimension:

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12
Q

Three Pathways Leading to Frailty

Physical Dimension: Changes of what occur?

A

Changes of aging and loss of organ reserve and function

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13
Q

Three Pathways Leading to Frailty

Physical Dimension: How does diagnosis occur?

A

Diagnosis with several chronic illnesses

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14
Q

Three Pathways Leading to Frailty

Psychological Dimension:

A

Cognitive issues

Anxiety, fear of falling

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15
Q

Three Pathways Leading to Frailty

Social Dimension:

A

Existence in harmful environments

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16
Q

Who is the largest consumers of healthcare, community services and long term care?

A

Frail Elder

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17
Q

What increases with age?

A

Frailty

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18
Q

Frailty Index for Elders (FIFE): What is it?

A

The Frailty Index for Elders (FIFE) was developed to assess for frailty risk in older adults using items collected in existing nursing datasets.

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19
Q

Frailty Index for Elders (FIFE): What is the purpose of this?

A

The purpose is to assess for frailty risk in older adults, to identify patients who are higher risk, to implement specific treatment, and prognosis estimation.

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20
Q

The Frailty Index for Elders (FIFE)

What are special considerations?

A

Special Considerations: Certain medical conditions (such as conditions causing vertigo) can heavily influence frailty score, not just age.

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21
Q

The Frailty Index for Elders (FIFE)

Score of 1-3 indicate?

A

A score of 1-3 indicates frailty risk

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22
Q

The Frailty Index for Elders (FIFE)

Score of 4 or more indicate?

A

A score of 4 or greater indicates frailty

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23
Q

The Frailty Index for Elders (FIFE)

What are clinical manifestations of frailty?

A

Clinical manifestations of frailty (include 3 or more)

Unintentional weight loss

Self-reported exhaustion

Weakness-diminished handgrip strength

Slow walking speed

Low level of physical activity

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24
Q

Risk Factors for Frail Older Persons

A

Dependency

Institutionalization

Falls

Injuries

Hospitalization

Slow recovery from illness

Increased risk of mortality

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25
Q

What is aging associated with?

A

Ageing is associated with increased prevalence of comorbidity and frailty that increase the risk of infections due to dysregulation of the immune system.

26
Q

Atypical Presentation of Illness in Older Adults

Older adults often present “atypically” when they are ill- they do not have the usual signs and symptoms seen with a particular illness

What is the most common example?

A

(Absence of fever with a disease known to cause fever is the most common presentation)

27
Q

Atypical Presentation of Illness in Older Adults

Older adults often present “atypically” when they are ill- they do not have the usual signs and symptoms seen with a particular illness

What are risk factors associated with atypical presentations?

A

UTI and dementia were risk factors associated with atypical presentations.

28
Q

Atypical Presentation of Illness in Older Adults

What are the first signs of illness in elderly?

A

Subtle changes like a decrease in functional status or a diminished/ loss of appetite very often are the first signs of illness in an older adult.

29
Q

Geriatric Giants include:

A

Geriatric Giants =“five I’s”:

immobility,

instability (falls),

incontinence,

intellectual impairment, and

iatrogenic complications,

e.g., resulting from inappropriate medication.

29
Q

Atypical Presentation of Illness in Older Adults

What are other common atypical presentations in older adults?

A

Other common atypical presentation in older adults:

Delirium, New onset urinary incontinence, a fall

30
Q

Atypical Presentation of Illness in Older Adults

So how do you differentiate age-related from illness-related signs and symptoms?

A

Illness indicators include change in mental status, falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence.

31
Q

Atypical Presentation of Illness in Older Adults

Why is dehydration common in elderly patients?

A

Dehydration is common for older adults; they do not drink because they do not want to get up to urinate.

32
Q

Consequences of Not Identifying Atypical Presentations

A

Increased morbidity and mortality

Missed diagnosis

Unnecessary use of Emergency Rooms

33
Q

Non-specific Symptomsthat may Represent Specific Illness

A

Confusion

Self neglect

Falling

Incontinence

Apathy

Anorexia

Dyspnea

Fatigue

34
Q

Geriatric syndromes: What are they?

A

common conditions found in older adults that tend to be multifactorial and do not fit a specific disease category:

35
Q

Geriatric syndromes: common conditions found in older adults that tend to be multifactorial and do not fit a specific disease category

What does it include?

A

Falls, frailty, malnutrition, urinary incontinence, functional decline, pressure ulcers, cognitive impairment, and delirium

36
Q

Geriatric syndromes: common conditions found in older adults that tend to be multifactorial and do not fit a specific disease category

What are the most common geriatric syndromes in hospitalized older adults discharged to skilled nursing facilities

A

most common geriatric syndromes in hospitalized older adults discharged to skilled nursing facilities are falls, nutritional problems, incontinence and depression.

37
Q

Other conditions that are considered geriatric syndromes:

A

Adverse medication effect, elder abuse, dementia and delirium, depression, hearing loss, visual impairment, malnutrition, urinary incontinence, falls and osteoporosis, pressure ulcer sleep disturbances and pain

38
Q

Geriatric Syndromes diminish

A

Geriatric Syndromes diminish older adult’s ability to adapt to stressors and is associated with poor outcomes

39
Q

What is the relationship between frailty and geriatric syndrome?

A

Frailty can be seen as a contributing factor to the development of geriatric syndromes, as frail individuals are more susceptible to experiencing these syndromes due to their decreased physiological reserves and increased vulnerability.

40
Q

Which statement best describes the challenge of health assessment of the older adult?

A. Signs of infection with an acute illness are predictable

B. Symptoms of chronic conditions interact with acute conditions

C. Health problems are easily detected when they occur

D. Complications of illness are rare in people with cognitive impairment

A

B. Symptoms of chronic conditions interact with acute conditions

41
Q

Nursing Management/Comprehensive Geriatric Assessment

A

First attend to primary needs

Ensure assistive devices are used

Allow plenty of time

Interview family or caregivers separately

42
Q

Nursing Management/Comprehensive Geriatric Assessment

The focus of a comprehensive geriatric assessment is to:

A

The focus of a comprehensive geriatric assessment is to determine appropriate interventions to maintain and enhance the health, quality of life, function, and independence of older adults

43
Q

Geriatric Assessment Tools

What do they do and not do?

A

Assessment tools are used as a screening tool -they do not diagnose

44
Q

SPICES Assessment Tool: What is it used for?

A

To identify the following common syndromes that require nursing interventions:

Sleep disorders,

Problems with eating or feeding,

Incontinence,

Confusion,

Evidence of falls, and

Skin breakdown.

45
Q

What is cognitive functioning?

A

The processes by which an individual registers, perceives, stores, retrieves, and uses information

46
Q

In older adults, how does physical illness present

A

In older adults, physical illness often presents as changes in cognitive function

47
Q

The value of cognitive screening

When is cognitive screening done?

A

Patients screened ONLY when cognitive impairment is apparent

48
Q

The value of cognitive screening

What are tests for?

A

Tests are a way to objectify and quantify something that might be already a concern and complaint.

49
Q

Mental Status Assessment

Cognitive function decline:

A

dementias, delirium, and impaired thought process

50
Q

Mental Status Assessment

Indicators of general cognitive loss:

A

declining scores on tests of memory

51
Q

Mental Status Assessment : What do they do and not?

A

screens for changes in cognition and mood but does not diagnose

52
Q

Components of Mental Status Assessment

A

Alertness / Level of Consciousness

Attention

Comprehension

Construction

Emotional Status

Higher Memory Function

53
Q

Benefits of a Standardized Instrument to Describe Cognitive Status

A

Accurate

Consistent

Not left up to individual interpretation

Concise

Measure change over period of time

Communicate status of patient when transitioning between settings

54
Q

Mini Mental State Examination MMSE
Purpose:

A

The MMSE is a widely used screening tool to assess general cognitive function, including orientation, registration, attention, calculation, recall, and language.

The MMSE is a widely used screening tool to assess general cognitive function, including orientation, registration, attention, calculation, recall, and language.

55
Q

Mini Mental State Examination MMSE
Scoring:

A

Scoring: The maximum score is 30, with a score of 24 or above typically considered normal.

It uses a simpler scoring system with equal weight assigned to each question.

56
Q

Mini Mental State Examination MMSE
Cultural Considerations:

A

The MMSE may have limitations in individuals with lower education levels or from different cultural backgrounds.

57
Q

Montreal Cognitive Assessment (MoCA)

Purpose:

A

Used for early detection of mild cognitive impairment and to assess a broader spectrum of cognitive domains, including attention/executive functioning, visuospatial skills, and language.

58
Q

Montreal Cognitive Assessment (MoCA)

Purpose: assess a broader spectrum of cognitive domains like?

A

attention/executive functioning,

visuospatial skills, and language.

59
Q

Montreal Cognitive Assessment (MoCA)

Scoring

A

The maximum score is 30, with a score of 26 or above generally considered normal. It uses a weighted scoring system to provide a more comprehensive assessment.

60
Q

Mini-Cog Tool: Purpose

A

Purpose: The Mini-Cog is a brief screening tool for cognitive impairment that combines a three-item recall test with a clock-drawing task.

61
Q

How does the Mini Cog compare to moCA and MMSE?

A

Length: The Mini-Cog is shorter and quicker to administer compared to the MoCA and MMSE.

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