Module 1 - Introduction to Advanced Practice for Older Adults Flashcards
What is functional reserve?
body systems tend to have functional ability over and above what is used during everyday activities - this is called functional reserve.
What is the rule of fourths?
of changes often attributed to normal aging about one fourth is due to disease, one fourth to disuse, one fourth to misuse, and one fourth to physiologic aging.
What is frailty?
When reduced stamina and fatigue are so great that they become the defining feature of one’s physiologic status.
Fried et al. define it as the occurrence of three or more of the following: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (reduced grip strength), slow walking speed, and low physical activity.
What is ageism?
the systemic stereotyping of and discrimination against people because they are old.
Ageism can lower self-esteem, reduce opportunities, and lead to isolation, loneliness, and depression.
Name key elements of a successful physiological adjustment to aging.
- Developing a sense of satisfaction with one’s accomplishments
- enjoying the advantages that come with being older (such as grandchildren, a slower pace, and ability to choose how one spends time)
- developing a new sense of both serenity with and ability to enjoy each day as it comes.
Discuss activity versus disengagement.
Disengagement theory - posited that letting go of the trappings of earlier life was the key to successful aging. Such as an old man in a rocking chair on his porch.
Activity theory - posited that staying active and engaged was the key to healthy aging. Such as people who continue to work and be active in their communities well past retirement.
What is executive function impairment?
Executive function is a set of mental processes that helps connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space.
Warning Signs of Executive Function Problems:
A person may have problems with executive function when he or she has trouble:
- Planning projects
- Comprehending how much time a project will take to complete
- Telling stories - struggling to communicate details in an organized, sequential manner
- Memorizing and retrieving information from memory
- Initiating activities or tasks, or generating ideas independently
- Retaining information while doing something with it, for example, remembering a phone number while dialing
What are geriatric syndromes?
Geriatricians use the phrase “geriatric syndrome” to describe the unique features of common health conditions in older people that do not fit into discrete disease categories. These conditions include delirium, confusion, falls, incontinence, weakness, gait problems, and frailty.
What does “icebergs are common” refer to?
Frequently unreported symptoms.
Some symptoms in geriatrics are commonly undetected by physicians because the older person either thinks the problem is a normal part of aging or is embarrassed to talk about it. Prominent “icebergs” include, depression, cognitive impairment, incontinence, and musculoskeletal problems.
Specific screening for these should be routine for all persons older than age 75.
What is iatrogenic disease?
Illness caused by medical interventions.
Name three especially common iatrogenic problems in geriatrics.
- Adverse drug effects (ADE). Taking 5 or more medicines is a potent predictor of ADE’s. Regular review and discontinuation of unnecessary prescription and OTC drugs is a critical preventive measure.
- Acute Kidney injury. Risk factors include nephrotoxic drugs, sepsis, hypotension, and radiologic contrast - therefore known nephrotoxic drugs and contrast should be avoided whenever possible, and hydration should be maintained.
- Adverse surgical outcomes. Oler people as a whole are more prone to poor outcomes after surgery; thus many operations leave the patient worse off than before. We need to question whether they are too frail and whether or not the potential benefits justify the risks.
What is meant by “slow medicine”
The idea is to pace care decisions so that both patients and health care providers have a chance to evaluate care options before proceeding, because acting hastily is more likely to do harm than not acting at all.
“Start low, go slow” in another mantra of geriatrics that refers to the best way to approach pharmacotherapy in older persons.
Discuss transitions in care
Care transitions occur anytime a patient changes level or location of care or changes in providers of care.
This can be dangerous in the geriatric population because too many handoffs can lead to misunderstandings of diagnoses and plans, to medication discrepancies, and to confusion on the part of patients and families.
What are three key elements of high-quality transitional care?
- Accurate and timely information transfer to the next set of providers
- Patient and family education about the disease process, self-managment recommendations, and expectations for the next level of care.
- Empowerment of patients to assert their preferences for the type, intensity, and location of services received.
What is PACE?
Program of All-inclusive Care for the Elderly, or PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.
Who can get PACE?
You can have either Medicare or Medicaid, or both, to join PACE. To qualify for PACE, you must:
- Be 55 or older
- Live in the service area of a PACE organization
- Need a nursing home-level of care (as certified by your state)
- Be able to live safely in the community with help from PACE
