healthcare of the older adult Flashcards
what is ageism
stereotype/bias/discrimination that stigmatizes and disadvandtages older adults based on chronological age
what is comorbidity
having more than 1 illness at a time
what is delirium
sudden onset of confusion that is the result of illness/injury
generally reversible
can become fatal if not caught in time
what is dementia
long term loss of memory, cognition, confusion
slow and progressive
irreversible
describe depression
can be oten confused as dementia in the older adult
often ahve apathy
what is durable power of attorney (DPOA)
healthcare proxy
make decision in the event the patient can’t
describe elder abuse
can be mental, physical, financial, or neglect
often not reported/recorded
describe geriatric syndromes
multifactorial conditions prevalent in older adults
what is geriatrics
area of emdical field that deals with older people
what is gerontologic nursing
area of nursing that deals with the care of the older population
physiological, social, psychological, economic, cultural, spiritual, and advocacy for the needs of the older adult
what is gerontology
study of the older population
what is polypharmacy
taking multiple meds
describe the health status of the older adult
- most have at least 1 chronic illness
- major cause of disability and pain
- most deaths occur >65 years
describe theories of aging
- provide framework
- used to gain insight into different aspects of aging
- grouped into biologic, developmental, and sociologic aspects
- functional consequences theory (miller, 2012)
well-being of older people depends on following…
- physical (must determine normal aging changes vs pathological changes)
-
psychosocial (stress and coping, living arrangements, role of the fam)
-cognitive/mental (affected by sensory impairment, physiologic health, environment and sleep) - pharmacological (more prescription meds. altered pharmacokinetics, and adherance issues)
what are some mental health problems in the older adult
- depression
- substance use disorder
- delirium
- dementia
- alzheimers
- vascular dementia
what is the most common affective disorder of the older adult
depression
name and describe some different types of depression
- major: interferes with daily life
- persistant: lasts more than 2 years
- other types include psychotic, SAD, depression, other chronic conditions, or an adverse effects of meds
age-related changes
cardiovascular
- decreased cardiac output, slower heart recovery rate, increased blood pressure
- complaints of fatigue with activity
- tx: regular exercise, avoid smoking, diet changes, adherance to meds, weight control
age-related changes
respiratory
- increase in residual lung volume, decrease in muscle strength, endurance, gas exchange, and cough efficiency
- fatigue and breathlessness with activity, difficulty coughing
- tx: regular exercise, avoid smoking, vaccinations, infection prevention
age-related changes
integumentary
- decerased subq fat, muscle tone, and sesory receptors
- thing, wrinkled, and dry skin;easily bruised and sunburned
- tx: limit sun exposure, stay hydrated, lotion and lube skin
age-related changes
reproductive (female)
- vaginal narrowing and decreased elasticity, decreased secretions, slower sexual response
- painful intercourse, vaginal itching and irritation
- tx: may require estrogen replacement
age-related changes
reproductive (male)
- gradual decline in fertility, less form tests and decreased sperm production, slower sexual response
- less form erection and delayed erection and achievement of orgasm
age-related changes
musculoskeletal
- loss of bone density and muscle strength and size
- height loss, prone to fractures, back pain, and loss of endurance
- tx: weight bearing exercise regularly, bone density screening, calcium and vitamin D suplements
age-related changes
genitourinary
- decrease in detrusor muscle contractility, bladder capacity, flow rate, and increased residual urine
- male: BPH
- female: urge incontinence and urethra dysfunction
- urinary rentention and urgency/frequency syndrome
- tx: drink adequate fluids and avoid bladder irritants, empty bladder completely when voiding
age-related changes
GI
- decreased senses and salivation, difficulty swalloing food and reduced motility
- risk for dehydration and poor nutritional intake, constipation and abdominal discomfort
- tx: good dental hygiene, small frequent meals, hydrate, and limit antacid and laxative use
age-related changes
nervous system
- decrease in brain volume and cerebral blood flow
- slower to respond and react, increased vulnerability to delirium, increased risk of falls
- tx: pace education, enhance senesory stimulation, fall prevention measures
age-related changes
vision
- presbyopia, glare problems, dry eyes
- wear glasses and large print books
age-related changes
hearing
- presbycusis - decreased ability to hear high pitched sounds
- recommend hearing exams and reduce background noise
what does SIGECAPS stand for
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal thoughts
what are some causes/risk factors for depression
genes, personal history, brain chemistry, stress
describe treatment of depression in older adults
treat underlying issues
if that doesnt work, antidepressants, psychotherapy, electroconvulsion therapy
whats included in medical management of depression
SSRIs, tricyclic antidepressants and MAOIs
most are avoided bc of adverse effects on the elderly
what are some common adverse effects of medication management with antidepressants
anticholinergic effects and orthostatic hypotension
describe delirium
- acute onset
- confusion develops over a short period of time
- most comon complication of hospitalized older adult
- may be the sign of an underlying medical condition
describe the outcomes of delirium
- possible full recovery with early detection and intervention
- may progress to stupor and/or coma, seizures, and death
describe assessment of delirium
assessment of risk factors:
- baseline or pre-morbid impairment
- pain
- metabolic, dehydration, infection
- environment
- impariemnt of mobility
confusion assessment methods (CAM) diagnostic algorithm
name three clinical subtypes of delirium
- hyperactive
- hypoactive
- mixed
describe hyperactive delirium
- increased psychomotor activity
- rapid speech
- irritability
- restlessness
describe hypoactive delirium
- lethargy
- slowed speech
- decreased alertness
- apathy
describe mixed delirium
shift between hyperactive and hypoactive states
whats included in delirium management
- multi-componenet interventions are most effective
- indentification of risk (HARP)
- prevention activities (watch closely)
- prompt treatment of underlying cause
- create maximum support system
- immediate medical treatment
- assess medications
describe dementia
a clinical syndrome of cognitive, fucntion, and behavioral changes
involves:
- sudden onset
- slow progession
- memory impairments
- disturbance in at least one other area of cognition
what are the most common forms of progressive dementia
- alzheimers disease (AD)
- vascular dementia (lack of bloodflow to brain and brain cells die)
- dementia with lewy bodies (can happen at any age)
other types include degenerative, neoplastic, demylenating, infectious, inflammatory, toxic, metabolic, psychiatric
is there a cure for AD
nope, no cure or preventative measures
what are some causes/risk factors for AD
causes may include a combo of risk factors like genetic, neurotransmitter changes, vascular changes, vascular abnormalities, stress, hormones, circadian changes, head trauma, seizure disorders
risk factors include advanced age, cognitive impairment, genetics, environement, dietary issues, immune issues
name two types od AD
- familial (early onset- rare)
- sporadic (late onset)
describe the clincial manifestations of AD
early stages: forgetfulness, subtle memory loss, difficulties in work/social life, but they are able to compensate
progression: loss of ability to recognize familiar faces/places/items, orientation and reasoning make more anxiety, loss of abstract thinking, personality changes, loss of functioning
terminal stage: immobile, total care, death d/t complications
how is a definitive diagnosis of AD made?
autopsy
need to r/o other possible causes of dementia
what can be used to make a probable diagnosis of AD
- health hx
- physical exam
- diagnostic tests
- assess for underlying depressiona dn cognitive function
what is included in AD nursing management
- support cognitive function
- promote safety
- promote independence in self-care activities
- reduce anxiety and agitiation
- improve communication/socialization
- promote adequate nutrition
- promote balnced activity/rest
- avoid the use of restraints
- encourage and support through advance care planning
describe progressively lowered stress threshold (PLST)
- framework for the nursing care of people with dementia
- need alternating quiet and stimulating environments
- behaviors have meaning
- check for physical problem, pain, and environemnt
name some geriatric syndromes
- impaired mobility
- dizziness
- falls and falling
- urinary incontinence
- changes in cognitive status
- increased susceptibility to infection
- atypical response
- altered emotional impact
- altered systemic response
what syndromes are components of the geriatric triad
- falls and falling
- urinary incontinence
- changes in cognitive status
what code says the healthcare professionals are required to report suspected abuse to job and family services?
ohio revised code
what code says department of health is to investigate allegations of abuse at long term care facilities
ohio administrative code
what are some risk factors for elder abuse
divorce/separation, low income, functional impairment, poor health
what are some barriers to understanding elder abuse
professionals are not equipped to recognize and report, or may be reluctant to report
what is neglect
not carig for the elder
what are some characteristics and abuser may have
- developmentally delayed
- substance abuse
- financially dependent on victim
elder mistreatment
physical abuse
- use of physical force that may result in injury, physical pain, or impairment
- shaking, slapping, kicking, pinching, burning, improper use of restraints, drugs, or force feeding
- signs and symptoms include bruises, black eyes, fractures, injuries in various stage of healing
elder mistreatment
psychological/emotional abuse
- infliction of pain or distress through verbal or nonverbal acts
- verbal threats, harrassment, isolation in the home, silent treatment
- signs and symptoms include extreme withdrawal, emotional upset or agitiation
elder mistreatment
sexual abuse
- nonconsenual sexual contact, with an elderly incapable in giving consent
- unwanted touching, coerced nudity, sexual harrassment
- signs and symptoms include genital bruising, unexplained STDs
elder mistreatment
financial exploitation
- taking advantage of eldee for money or personal benefit
- numerous unpaid bills, papers and credit cards missing, unable to pay for food and meds
- signs include new will when elder is incapable of writing one, frequent checks to cash, forged signatures, cargivers refusal to spend money on the elder
elder mistreatment
caregiver neglect
- intentional or unintentional to failure to meet the need sof the elders physical and mental well being
- failure to provide adequate food, clothing, shelter, medical care, hygiene, social stimulation
- signs and symptoms include dehydration, malnutrition, urine burns, left alone
elder mistreatment
self neglect
- personal disregard or inability to perform self care
- poor hygiene, unkept home environment
- signs and symptoms include malnurition, fungal, skin/nail infections, insect/rodent infestation
elder mistreatment
abandonment
- willful disertion of an elder
- dropping the elder off in ED and not coming back
- elder inappropriately left alone
elder mistreatment
institutional mistreatment
- disregard of contractual arrangement resulting in abuse or neglect
- signs include dehydration, urine burns, malnutrition
describe caregiver strain
- majority of long term care to chronically disabled older adults by the caregiver
- associated with premature tools to identify
what screening tools are used to identify caregiver strain
modified caregiver strain index
13 question tool that covers the following domains:
- financial
- physical
- psychological
- social
- personal
how do you document supected elder abuse
document only the facts, use direct quotes
what social service healthcare programs are available for elders
- medicare
- medicaid
- older americans act
- supplemental security income
- section housing
- title XX social services
other services:
- home health care
- hospice services
what two major programs finance health care in the U.S.
- medicare
- medicaid
both are through centers of medicaid and medicare
what is the nurses role in ethical/legal issues surrounding the older population
- informing and suporting
- encorage end of life discussions
- education on advanced directives (DNR/advanced directive, surrogate decision making, and patient self determination act)
describe the patient self determination act
law that states that any facility that is funded by medicare must provide patients with info on advanced directives
what ethical principles may nurses run into
- patient confidentiality
- access to complementary treatments
- faor distribution of resources
- economic decision making
