Gerontology Lecture II Flashcards
Exam 1
Characteristics of Illness in Older Adults
Presence of many interacting conditions and factors such as:
Acute illness
Chronic conditions
Psychosocial factors
Environmental conditions
Age-related changes
Medication effects
Comorbidity and the older adultchapter 28-pages 562-564
What is comorbidities?
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.
Comorbidity and the older adultchapter 28-pages 562-564
What does comorbidities focus on?
Comorbidity focuses on the relationship of additional diseases with a primary condition.
What is an example of comorbidities?
For example, if a person is diagnosed with diabetes (primary condition) and also has hypertension and depression, the latter two are considered comorbidities.
Multimorbidity:
combination of chronic (e.g., diabetes, congestive heart failure) and acute conditions ( infection/injury).
What is an example of multimorbidity?
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.
What accounts for the majority of healthcare needs?
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
Frailty
multisystem decline that increases vulnerability to poor health effects
What is the definition of frailty?
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.
Frailty-clinical manifestations
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
Three Pathways Leading to Frailty
Physical Dimension:
Social Dimension:
Psychological Dimension:
Three Pathways Leading to Frailty
Physical Dimension: Changes of what occur?
Changes of aging and loss of organ reserve and function
Three Pathways Leading to Frailty
Physical Dimension: How does diagnosis occur?
Diagnosis with several chronic illnesses
Three Pathways Leading to Frailty
Psychological Dimension:
Cognitive issues
Anxiety, fear of falling
Three Pathways Leading to Frailty
Social Dimension:
Existence in harmful environments
Who is the largest consumers of healthcare, community services and long term care?
Frail Elder
What increases with age?
Frailty
Frailty Index for Elders (FIFE): What is it?
The Frailty Index for Elders (FIFE) was developed to assess for frailty risk in older adults using items collected in existing nursing datasets.
Frailty Index for Elders (FIFE): What is the purpose of this?
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.
The Frailty Index for Elders (FIFE)
What are special considerations?
Special Considerations: Certain medical conditions (such as conditions causing vertigo) can heavily influence frailty score, not just age.
The Frailty Index for Elders (FIFE)
Score of 1-3 indicate?
A score of 1-3 indicates frailty risk
The Frailty Index for Elders (FIFE)
Score of 4 or more indicate?
A score of 4 or greater indicates frailty
The Frailty Index for Elders (FIFE)
What are clinical manifestations of frailty?
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
Risk Factors for Frail Older Persons
Dependency
Institutionalization
Falls
Injuries
Hospitalization
Slow recovery from illness
Increased risk of mortality
What is aging associated with?
Ageing is associated with increased prevalence of comorbidity and frailty that increase the risk of infections due to dysregulation of the immune system.
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?
(Absence of fever with a disease known to cause fever is the most common presentation)
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?
UTI and dementia were risk factors associated with atypical presentations.
Atypical Presentation of Illness in Older Adults
What are the first signs of illness in elderly?
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.
Geriatric Giants include:
Geriatric Giants =“five I’s”:
immobility,
instability (falls),
incontinence,
intellectual impairment, and
iatrogenic complications,
e.g., resulting from inappropriate medication.
Atypical Presentation of Illness in Older Adults
What are other common atypical presentations in older adults?
Other common atypical presentation in older adults:
Delirium, New onset urinary incontinence, a fall
Atypical Presentation of Illness in Older Adults
So how do you differentiate age-related from illness-related signs and symptoms?
Illness indicators include change in mental status, falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence.
Atypical Presentation of Illness in Older Adults
Why is dehydration common in elderly patients?
Dehydration is common for older adults; they do not drink because they do not want to get up to urinate.
Consequences of Not Identifying Atypical Presentations
Increased morbidity and mortality
Missed diagnosis
Unnecessary use of Emergency Rooms
Non-specific Symptomsthat may Represent Specific Illness
Confusion
Self neglect
Falling
Incontinence
Apathy
Anorexia
Dyspnea
Fatigue
Geriatric syndromes: What are they?
common conditions found in older adults that tend to be multifactorial and do not fit a specific disease category:
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?
Falls, frailty, malnutrition, urinary incontinence, functional decline, pressure ulcers, cognitive impairment, and delirium
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
most common geriatric syndromes in hospitalized older adults discharged to skilled nursing facilities are falls, nutritional problems, incontinence and depression.
Other conditions that are considered geriatric syndromes:
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
Geriatric Syndromes diminish
Geriatric Syndromes diminish older adult’s ability to adapt to stressors and is associated with poor outcomes
What is the relationship between frailty and geriatric syndrome?
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.
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
B. Symptoms of chronic conditions interact with acute conditions
Nursing Management/Comprehensive Geriatric Assessment
First attend to primary needs
Ensure assistive devices are used
Allow plenty of time
Interview family or caregivers separately
Nursing Management/Comprehensive Geriatric Assessment
The focus of a comprehensive geriatric assessment is to:
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
Geriatric Assessment Tools
What do they do and not do?
Assessment tools are used as a screening tool -they do not diagnose
SPICES Assessment Tool: What is it used for?
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.
What is cognitive functioning?
The processes by which an individual registers, perceives, stores, retrieves, and uses information
In older adults, how does physical illness present
In older adults, physical illness often presents as changes in cognitive function
The value of cognitive screening
When is cognitive screening done?
Patients screened ONLY when cognitive impairment is apparent
The value of cognitive screening
What are tests for?
Tests are a way to objectify and quantify something that might be already a concern and complaint.
Mental Status Assessment
Cognitive function decline:
dementias, delirium, and impaired thought process
Mental Status Assessment
Indicators of general cognitive loss:
declining scores on tests of memory
Mental Status Assessment : What do they do and not?
screens for changes in cognition and mood but does not diagnose
Components of Mental Status Assessment
Alertness / Level of Consciousness
Attention
Comprehension
Construction
Emotional Status
Higher Memory Function
Benefits of a Standardized Instrument to Describe Cognitive Status
Accurate
Consistent
Not left up to individual interpretation
Concise
Measure change over period of time
Communicate status of patient when transitioning between settings
Mini Mental State Examination MMSE
Purpose:
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.
Mini Mental State Examination MMSE
Scoring:
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.
Mini Mental State Examination MMSE
Cultural Considerations:
The MMSE may have limitations in individuals with lower education levels or from different cultural backgrounds.
Montreal Cognitive Assessment (MoCA)
Purpose:
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.
Montreal Cognitive Assessment (MoCA)
Purpose: assess a broader spectrum of cognitive domains like?
attention/executive functioning,
visuospatial skills, and language.
Montreal Cognitive Assessment (MoCA)
Scoring
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.
Mini-Cog Tool: Purpose
Purpose: The Mini-Cog is a brief screening tool for cognitive impairment that combines a three-item recall test with a clock-drawing task.
How does the Mini Cog compare to moCA and MMSE?
Length: The Mini-Cog is shorter and quicker to administer compared to the MoCA and MMSE.
