lecture 1 Flashcards
aged, aging, elder, elderly, old
> /= 65
young-old
65-74
middle-old
75-84
old-old
85+
fastest growing segment of aging population?
85+, old-old
elite-old, centernarians
100+
ave life span for female infants
81.1
ave life span for male infants
76.2
frail
related to functional status, not age
what % live in community?
95%
what % live in CA FL NY PA TX OH IL MI
52%
what % live in urban areas?
77%
fastest growing group of elders
women 85+
what % of those >65 live alone?
> 36%
changes in elder pop? what we know
^ in absolute # of persons 65+ ^ in % of persons 65+ ^ life exp at birth & at age 65 dramatic changes in ethnic div major ^ in education achievement
changes in elder pop? what we dont know
- implications of current lifestyle/behavior patterns on future health status
- availab/type of health care resources
- disease/tx response patterns for diff demograph groups
- implications of scientific/technical advances for health & quality of life
top 10 causes of death in elders
heart disease cancer cerebrovascular diseases COPD and assoc conditions pneumonia/ flu diabetes accidents septicemia kidney disease alzheimers
elder abuse
battering, verbal abuse, exploitation, denial of rights, forced confinement, neglected med needs, personal harm, usually at the hands of someone responsbile for assisting them in ADLs
what happens as violence in society increases?
likely ^ in elder abuse
how much abused/neglected elders are there each year?
> 2 mil
how much elder abuse is under reported?
est 80%
how much of abuse involves elders?
40%
why are elders reluctant to report abuse?
fear worse/unsure situation if they get moved
abuse is usually related to what?
limited resources of time, money, coping, help, substance abuse
what % is financial abuse?
46%
neglect by self
story about woman who didnt wanna abuse friendship with woman who drove her to tx.
most frequent type of mistx
largest # of elderly living at home alone
women 75+, can be subject to self neglect, abuse and exploitation by hired caregivers
what is related to long-standing problems in a relationship?
verbal abuse/ neglect
“better quicker”
philosophy in hospitals- pts sent home earlier with more sophisticated needs and more demands on the family for care.
why is the “better quicker” philosophy not good?
increases stress, fam can be resistant to care for pt. pt may get inadequate care, neglected
families/cg at home make up what % of care?
80%
why do families take care of pts?
mostly due to costs of institutional care
physical assessment
normal aging and comorbidities
nutritional assessment
functional assessment
ADLs, InstumentalADLs, timed up and go, gait/balance
psychological assessment
cognitive/mental status assessment
ie depression assessment, mental exams
social assessment
relationships and network size
spiritual assessment
doesnt have to be religion. do you have faith? something that can sustain you when youre sick?
normal aging changes
alterations at all levels dec reserve/efficiency -intracell -cellular -tissue -organ -system
cumulative effect of inc vulnerability
diff maintaining homeostasis
diff responding to stress
top 10 chronic conditions
HTN arthritis heart disease hearing impairment cataracts deformity/ortho impairment chronic sinusitis diabetes tinnitus visual impairment
functional evaluation
tell about typical day, ADLs, IADLs, performance measures
nutrition eval
nutrition screening ?aire, current wt, wt trend, BMI, Albumin, Cholesterol
underweight BMI
< 18.5 kg/m2
healthy weight BMI
18.5-24.9
overweight BMI
25-29.9
26- protective for immune system
obese BMI
> 30.0
albumin level
3.5-4 g/dL
less than 3.5 albumin means what
malnourishment
why use prealbumin?
actually see more quickly over time. Half life is 2 days vs. 12-18 days for albumin.
cholesterol
160-200
cognitive, mental status screening
remember 3 objects
mini mental status exam (MMSE)
Short portable mental status ?aire (SPMSQ) 10 items
clock drawing test
depression screening
GDS geri dep scale
full scale GDS
30 y/n ?s
short scale GDS
15 items
if pt has plan to kill themselves
get help right away
if pt just feeling depressed, say they dont wanna live
need to follow up, but not an emergency situation
assessment of SS
if something happens, who can help u? how long do you see yourself being able to manage? primary cg? is cg burdened? resources?
polypharm
know why each drug given.
know AE.
know interactions bw other drugs.
pharmacokinetics
how body acts on drugs, how drug moves on body. ADME
pharmacodynamics
actual effects, results. was there toxicity? was it efficacious?
what happens if someone is on digoxin while anemic?
drug wont be connected to proteins (albumin) and will stay in blood. There will be digoxin toxicity. will see halo/yellow spots, bradycardia, NV, HA
most drugs are metabolized thru the?
liver
most drugs are excreted thru the?
kidneys
Drug-receptor interactioin
inc BBB permeability and receptor sensitivity; CNS side effects common.
Circulation
dec HR/BP regulation stability; toxicity common
Metabolism
dec liver mass and hepatic BF; dec metab; enzyme changes may inc drug 1/2 life
Excretion
dec renal BF, GFR, # functional nephrons; renal excretion slowed, inc drug 1/2 life.
Absorption
gastric emptying, GI motility, dec efficient
Distribution
dec lean body mass, total h20 and plasma protein; inc risk of drug toxicity.
loop diuretics
low K causes digoxin toxicity. K enhances action of drug… can have arrythmias.
QSEN competencies
- Patient-centered care
- Teamwork/collab
- EBP
- Quality improvement
- Safety
- Informatics
patient centered care
to recognize the pt or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for pt’s preferences, values, and needs.
