OCTA 236 (Geriatrics) Final Lecture Exam Flashcards
What is the role of OT in Hospice?
focus on life and death issues, prepare person/family for death
Medicare:
- Passed into law in 1965 under president Lyndon Johnson
- federal/consistent
- Covers those 65+
- Covers those under 65, disabled for 24 continuous mths and receives SSI
- Covers those under 65 who have received social security disability for ALS
- Covers those 65 and under that have a dialysis/kidney tranplant
Largest payer of healthcare in the US
Medicare
Medicare Part A:
Inpatient services, including stays at hospitals, SNF, home health visits, and hospice
Medicare Part B:
- Optional but strongly recommended
- Outpatient services, physician costs, OT/PT/SLP, MD/other healthcare providers, preventative services, home health, DME (optional-pay monthly premium)
Medicare Part C:
Medicare advantage- HMO has a contract with Medicare to provide services (ex. John Hopkins, University)
Medicare Part D:
Medication coverage
Medicaid:
- Passed in 1965 under president Lyndon B. Johnson
- Federal and State partnership
- Covers income 20% federal poverty level
- children and seniors
- Adults with D children
- Pregnant and severe disabilities
What are examples of DME?
- Shower bench
- Walker
- Cane
- Wheelchair
- Hospital bed
- Bedside commode
What is the Omnibus Budget Reconciliation Act (OBRA)?
- Landmark Act of Congress
- Focus on Elder’s Right
- Focus on Quality of Care
- Quality of Life in a Nursing Home
- Initially went into effect 10/90
- Revised in 1995
What is the Minimum Data Set (MDS)?
- Screening tool
- Strengthens/deficits recognized; OT can actively be involved in this
- Process that covers many areas
Medical Model:
- Individually based
- Person enters the system when ill
- Physician Referral Required/Team Leader
- Services rendered in hospital/clinic or some other type of medical setting
- Third Party Payer requirements
- Reactive vs. Pro-active
Community Model:
- Individually or grouped based
- Focus is on the well population
- Prevention is emphasized
- Services are provided in the community ( examples: community center, shelter, church)
- Variety of funding sources/ grant funding sought.
Medical Model:
- Prof. Is responsible
- Prof. Has power
- Prof. Makes Decisions
- Prof. Is the expert
- Prof. Answers to the agency
- Planning is fragmented
- Culture is denied
Community Model:
- Client is responsible
- Client has power
- Client makes decision
- Client is the expert
- Prof. Answers to the client
- Planning is coordinated
- Culture is appreciated
admission may be the result of an acute illness such as a CVA. Admission may be through the ER.
Acute care hospital
provides post acute care services
Transitional Care Units, Sub-acute units, (SNF),
Acute Rehab Setting UMROI or National Rehab Hospital(NRH)
Rehabilitation Units
services are provided in the person’s home
Home Health
(hospital based, free-standing setting, SNF, private practice)
Out-patient
illness is not responsive to curative treatment
Palliative Care
can be offered via hospitals, private agencies, religious groups.
Respite Care
Why the community?
- Sense of familiar surroundings
- Personal identity
- Personal Control
- Sense of Freedom
any method (physical/chemical) of restricting an individual’s freedom of movement, physical activity or normal access to the body
restraint
Chemical Restraint
- A drug used to restrict a person’s movement or control their actions
- Not a specific treatment for a person’s disease.
Applying Restraints
- Fasten ties so they can be released quickly in case of an emergency.
- Always follow manufacturer’s instructions.
- Protocol/Standards of Care should be developed for a specific condition or procedure. This should be used 100% of the time. If in place, a MD’s order is not needed. ( Example: Helmet used as a
Protective device)
cognitive disorders that can be caused by general medical conditions, head trauma, or the persistent effects of substance abuse
Dementia
characterized by intellectual decline, disorganization of the personality and functional decline
Irreversible Dementia
Symptoms of dementia:
- Slow and progressive disease
- Four stages on page 283 of AD
- From the time of onset to death it could last approx. 10 –15 years. (Generally)
- In the beginning , short term memory deficits noted with recent events
- Difficulty with new learning
- Impaired concentration
- Decrease ability to mange self- care skills
- As the symptoms progress , pt. can become bedridden.
- Confabulation: reciting imaginary events to fill in gaps of memory
- Impaired executive functioning: difficulty with abstract thinking; difficulty with planning ; and unable to sequence events
- Memory ( Short-term)
- Affects ability to remember old information ( retention and recall)
Symptoms of Dementia continued:
- Aphasia: language deficit ( receptive and an expressive component)
- Inability to understand verbal/ written language.
- Apraxia: inability to perform a task with intact motor/sensory systems. ( Motor Planning)
- Agnosia: inability to recognize familiar objects.
a term referring to intentional or negligent act by a caregiver or any person that causes harm or serious risk to a vulnerable adult
Elder abuse
bodily harm, physical pain, hitting, slapping, kicking, burning
physical abuse
unexplained venereal disease or genital infections, forced sex intimacy coerced nudity, photographs
sexual abuse
upset/agitated, extremely withdrawn or non-communicative/non- responsive, verbal threats, intimidation, bullying, isolating from others
emotional/psychological abuse
dehydration, malnutrition, untreated bed sores ,poor personal hygiene, untreated health issues; failure to provide basic needs ( food, water, medicine)
neglect
sudden changes in bank account/bank practices, inclusion of names on accounts, unexplained transfers, unpaid bills despite the availability of adequate resources; misuse/steal a person’s funds, forgery, force an elder to sign over assets.
financial/material exploitation
desertion of an elder at the hospital/SNF/public location, elders own report
abandonment
dehydration, malnutrition, hazardous living conditions, inappropriate/inadequate clothing; person refuses to eat, take meds, drink fluids
self neglect/abuse
OT role in elder abuse:
- Report suspected abuse to the appropriated agency or department within your work organization.
- Submit a written report
- Adult Protective Services
- Occupational Therapy Ethics (2000) – Principle one (1) and Principle (5) see article .
- Advocate for your patient/client.
- If possible connect with resources
Older Americans Act: Title VII Vulnerable Elder Rights Protection:
- When the act was re-authorized in 1992, Congress created and funded a new Title VII, Chapter 3 for prevention of abuse, neglect, and exploitation .
- Provisions have been made for long-term care, ombudsman programs, and state legal assistance development.
Physical Exam will show signs of abuse:
- new injuries
- poor pain management
- poor hygiene
- STD’s
- bruises (especially UE)
- fractures, dislocation, lacerations, burns
What to observe for elder abuse:
low self esteem anxious fearful withdrawn depressed moodiness suicidal thoughts expressed * how elder responds to family member and caregiver
Family Centered Approach:
- This approach enables the family to take care of love one.
- Greater therapeutic outcomes noted
- This approach requires the OT practitioner to incorporate family education/training early in the intervention process.
- Caregiver may be taught how to position the elder, P/ROM, assist with mobility skill,
Transfer training, ADL training, and communication strategies. - The COTA may need to help identify community resources for the family.
- Provide support to the caregiver to reduce caregiver stress.
- COTA should function as facilitators, educators, and resource personnel.
Tasks can be overwhelming:
- Unfamiliar role
- Role reversal – child taking care of parent
- Difficult to meet the basic needs of the elderly
- Provide socialization opportunities
- Adult child may still be in workforce and raising children at home.
Signs of caregiver stress:
- deny the disease
- anxiety about future
- depression
- exhaustion and sleepiness
- irritability
- lack of concentration
- express anger that there is no effective tx for chronic illness
- experience mental and physical health problems
Ways to reduce caregiver stress:
- diagnose stress early
- take care of self
- accept changes
- don’t ignore behavior
- become educated
- know resources
- legal’financial planning
- respite/help
- be realistic
- manage stress with relaxation techniques
- “give yourself credit, not guilt”
Symptoms of Alzheimer’s Disease:
- slow and progressive
- from the time of onset can last 10-15 years
- difficulty with new learning
- impaired concentration
- decreased ability to manage self skills
- as symptoms progress pt can become bedridden
- confabulation- reciting imaginary events to fill gaps of memory
- impaired executive function- difficulty with abstract thinking, planning, and unable to sequence events
- affects ability to remember/recall old info
- Aphasia- language deficit
- inability to understand verbal/written language
- Apraxia- inability to perform task w/ intact motor/sensory systems (motor planning)
- Agnosia- inability to recognize familiar objects
What are the joint protection principles?
- Respect for pain
- Balance activity and Rest
- Avoid activities which cannot be stopped
- Use larger and stronger joints for activities
- Avoid standing one position for long periods of time
- Maintain or use your joints in good alignment
What is the purpose for licensure?
to be able to practice/provide OT services
Standard Precautions:
- Wash hands before and after pts
- Wear gloves
- Wear mask, protective eye wear, and gown during splashes or sprays
- Handle needles & other sharp instruments safely
- Routinely clean and disinfect surfaces
- Clean and disinfect linens & launder them safely
- Place pts with contaminated blood or body fluids in an isolation room
What i does GDS stand for?
Global Deterioration Scale
provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer’s Disease
Global Deterioration Scale
7 Stages of Dementia:
Stages 1-3: pre-dementia stages
Stages 4-7: dementia stages
At what stage of dementia can a person no longer survive without assistance?
Stage 5
7 Stages of Dementia
Stage 1: No cognitive decline Stage 2: Very mild cognitive decline Stage 3: Mild cognitive decline Stage 4: Mild dementia Stage 5: Moderate dementia Stage 6: Moderately severe dementia Stage 7: Severe dementia
