Intro/Geriatric Assessment/Resources Flashcards
What are the demographic trends of the aging population?
- People > 65 is increasing (70 million by 2030)=1/5 of Americans
- Women live longer than men (d/t estrogen, less smoking, more likely to seek medical attention and less hazardous jobs)
What are the myths about the elderly? (6)
- Majority of elderly are alone or isolated
- Majority have bad health
- Tend to be more religious
- Don’t engage in sex (truth: >65=highest growing rate of HIV)
- Majority live in nursing homes or other facilities
- Majority are poor
What are the top 3 causes of mortality?
- Heart disease
- Malignancy
- Stroke
What are the top 3 causes of morbidity?
- Arthritis
- HTN
- Hearing impairment
(Tend to have more co-morbidities–> biopsychosocial approach is required)
What are the 4 “geriatric giants” (disabilities representing to common final pathway of many chronic diseases)?
- Incontinence
- Immobility
- Instability (–> falls)
- Intellectual impairment
What are the 3 different types of living arrangements available to seniors?
- Independent living (at home)
- Assisted living
- Nursing home (aka skilled nursing facility (SNF))
Describe independent living.
Completely independent OR
With family or caregiver OR
W/ or w/o adult daycare (bus comes to pick them up for social activities or some type of therapy.
Which living situation is “Most ideal as long as it’s safe”?
Independent Living
Describe assisted living.
Between independent living and nursing homes.
Not able to live by themselves but don’t need constant care (help w/ making meals, housekeeping, etc.) – but NO MEDICAL CARE.
Aka = residential care, board and care, domiciliary care, supported care, adult homes, sheltered housing, retirement residences.
Describe Nursing home.
***Contains RNs who provide 24 hour care and a doctor who supervises.
Skilled medical care includes services of trained professionals that are needed for a limited period of time following an injury or illness (nurse, physical, speech or occupational therapists).
Custodial or personal care = help w/ bathing, dressing, eating, grooming, getting up, toileting.
Can be temporary (after surgery, etc.) or long-term (people who are losing their function).
What is the difference between skilled nursing care and custodial care?
Who provides the care and who pays differs.
***Which living situation is the “fastest growing trend”?
Assisted living.
***What is the #1 reason a senior is put in a home (institutionalized)?
caregiver burnout (also predicts risk of elder abuse)
What does Medicare Part A pay for? Who qualifies? What facilities does it cover?
- Pays for care in specified facilities if they are medically necessary based on Medicare requirements.
- ***Free if you worked and payed social security taxes for 10 years (40 calendar quarters. If not, pay premium).
- Covers: Inpatient care in hospitals (including critical access hospitals), Skilled nursing facilities (SNFs), Long Term Care Hospital (LTCH) , Inpatient Rehabilitation Facility (IRF), Hospice care, Home health care, Inpatient Mental health/psychiatric care.
What does Medicare Part B cover? Is it free?
- Covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services (physical, speech and occupational therapy), laboratory tests, x-rays, drugs, mental health care, and some home health and ambulance services.
- ***NO!!! There is a monthly premium for this coverage.
What does Medicare Part D cover? Who provides this coverage? Is it free?
- Covers prescription drugs.
- Provided only thru private insurance companies that have contracts w/ the government – never provided directly by the government.
- ***Optional = extra cost
What is Medicaid (aka MediCal in California)?
- Funded by state and federal
- Eligibility based on income
- Some states provide dental, vision, hearing, and community based serves (IHSS).
What does Medi-Medi mean?
Dual eligible (medicare + mediCal)
What makes a geriatric assessment different from a standard medical assessment?
- Includes nonmedical domains (caregiver, insurance, mobility)
- Emphasizes functional capacity and quality of life
- Incorporates a multidisciplinary team
***Vaccinations: When should you administer the influenza vaccine? Can you give intranasal? What allergies should you ask about?
October (takes 2 weeks to activate).
No!
Allergies: chicken eggs, prior flu shot.
***Vaccinations: When should you administer the Shingles vaccine? What allergies should you ask about?
CDC recommends >60yo; FDA says >50yo is ok.
Allergies: gelatin.
*Don’t give to immunocompromised b/c live vaccine.
***Vaccinations: When should you administer the Pneumococcal vaccine?
> 65yo (Give 13 and 23 valent)
ROS is important in the assessment of the elderly. What are the two main components?
- Basic Activities of Daily Living (Basic ADLs)– Katz Scale
- Instrumental Activities of Daily Living (IADLs)
What are the Basic Activities of Daily Living (Basic ADLs)– Katz Scale (6)?
- Bathing (no assistance or assistance bathing only one part of body)
- dressing (no assistance except w/ shoe tying)
- toileting (no assistance but may use: cane/walker for support, bedpan/urinal at night, catheterize self intermittently)
- continence (complete control w/ no accidents)
- transferring (get out of bed/chair w/o assistance; may use: cane/walker, electric lift chair)
- feeding (gets food to mouth w/o assistance; food prep may be done by someone else)
