Older Adults Flashcards
Health Status of Older Adults
Age Group: 65 years or older
Growth in number and proportion of older adults living in the United States; projected to reach almost 30% of population by 2060
Increased demands on public health system, medical and social services, and health care delivery
Chronic disease contributing to disability, diminished quality of life, and increased health care costs
Globally: # of adults over age 65 expected to reach 1.4 billion by 2050
- Those over age 80 years growing faster than any other group
National Health Status of Older Adults
Increased life expectancy (females > males)
Older adults healthier than ever before
Young–old (65–75 years)
Old–old (75–85 years)
Oldest old (85–100 years); approximately 40%
Elite-old (centenarians)
Frail elderly (over age 85 years and need assistance with ADLs)
Common Misconceptions About Older Adults
Inability to live independently
Most w/ diminished intellectual capacity or senility
Homogeneity: All alike w/ no individual differences
Inability to learn new things
W/drawn, inactive, nonproductive
Liability: Expensive, drain on economy
Characteristics of Healthy Older Adults
Lifetime of healthy habits
Strong social support system
Positive emotional outlook
Affected by
- Personality traits
- Life experiences
- Current physical health
- Current societal supports
Health Needs of Older Adults: Primary Prevention
Health education; Follow-through of sound personal health practices;
- Recommended immunizations
- Good Oral Health
Nutrition, oral health, exercise, safety needs, sleep
Economic security needs: Retirement, Social Security
Psychosocial needs
- Maintaining independence
- Social interaction
- Companionship
- Purpose
Spirituality, advance directives
Top 5 Immunizations for Adults
COVID-19
Influenza
Pneumococcal
TDAP
Zoster Recombinant
Health Needs of Older Adults: Secondary Prevention
Patient is at risk for colon cancer, colorectal cancer, breast cancer, osteoporosis, prostate cancer
Colonoscopy, Mammogram, Prostate-Specific antigen, Dexa Scan,
Focuses on early detection of disease & prompt intervention
Routine screening for HTN, diabetes, cancer
Health Needs of Older Adults: Tertiary Prevention
Patient already has a disease
Ex) Treating a patient w/ syphilis using Penicillin
Follow-up & Rehab
Health Issues:
- Alzheimer’s disease
- Arthritis
- Cancer
- Depression
- Diabetes
- Cardiovascular Disease
- Osteoporosis
Common Health Problems of Older Adults
Alzheimer’s Disease
Arthritis: Leading cause of disability
Cardiovascular Disease (Leading causes of Death): CHF, prolonged HTN, PVD
Cancer: Age is a significant risk factor
- If history of family history, have them screened for that type of cancer 10 years prior
Depression
Diabetes: Focus on med management, diet change, exercise
- A1C
Hearing Loss
Obesity
Osteoporosis:Dextra Scan
Elder Abuse
Intentional or neglectful acts by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult
Tends to go underreported
- No one witnessed it
- Facility’s are reluctant to report due to threat of lawsuit
Physical Abuse
Neglect
Emotional or psychological abuse
Verbal abuse & threats
Financial abuse & exploitation: Most common type
Sexual abuse
Abandonment
Criteria for Effective Health Services
Comprehensiveness
Affordable housing options
Adult day and memory care programs
Access to high-quality health care services
Health education (including preparation for retirement)
In-home services
Recreation and activity programs
Specialized transportation services
Safe and outdoor spaces
Services for Healthy Older Adults
Goal: Maintenance of Functional Independence
Living arrangements & care options
- Skilled nursing facilities
Intermediate care; assisted living
- Personal care homes
Continuing care retirement communities
Presbyterian Village, Austell
St. George Village, Roswell
Respite care services
Hospice and palliative care
If a patient needs around-the-clock care…
…they need to go to a nursing care
Respite Care Services
Gives caregivers a break
Palliative Care
Consists of comfort & symptom management
Does NOT provide a cure
Primarily intended to relieve the burden of physical & emotional suffering that often accompanies the illness associated w/ aging
Community Health Nursing in an Aging America
Case management for resources & referral (MOST IMPORTANT)
Encouragement of healthy lifestyle changes to avoid disease & disability
Development of creative living arrangements & services
Education about immunizations & safety measures including fall prevention
Home Health Care
Focus is on the 3 levels of prevention
Home Health Nursing
Focus is on empowerment for highest possible levels of function & health (PICC line, Foleys, PEG tubes)
Hospice & Palliative Care
Focus is on optimizing quality of life for those experiencing lime-limiting, progressive illness
Prognosis is less than 6 months
Home Health
Provide care at home
- Help pts & their families achieve improved health & independence in a safe environment
Medicare-certified or Social Security Disability
Recipients have diverse needs
- Most common dx is circulatory disease, followed by neoplasms, & endocrine diseases (especially diabetes)
Skilled Nursing Services
- Wound Care
- Trach Care
- Foley Care
- G-Tube Care: Peg or NG
- Central lines
National & state regulations in place
OASIS (Home Health Outcome & Assessment Information Set)
Contains data items developed to measure patient outcomes & to improve home health care
OASIS Assessments are required of ALL home health agencies certified to accept Medicare & Medicaid Payments
Very detailed & time consuming but thorough assessment that sets up what care the client needs & effective case management
Practice Linkages
Outcome and Assessment Information Set (OASIS)
- Designed to demonstrate improved, cost-effective client outcomes
Two key OASIS target areas
1) Medication management
2) Infection prevention
OASIS-> Outcome eval-> Outcome management-> Resource Management-> Cost-effective, quality care
Home Health Clients
Clients include individual, family, significant others
Individuals are predominantly: Older than 65 years, but not exclusively
Individuals tend to:
- Have chronic health needs (e.g., diabetes, COPD, CHF)
- Rely on care from family members (who may exhibit signs of compassion fatigue)
Home Health Interdisciplinary Team
Home health care nurses: RNs, LPNs
- RNs: Initial assessment
- LPNs: Follow-up and do nursing skills
Home care aides and personal care attendants
Physical therapists and staff: Gross Motor Skills
- Walking
Occupational therapists and staff: Fine Motor Skills
- Eating
- Writing
Social workers: Obtain resources
Administrative personnel
Reimbursement for Home Health Care
Corporate: Insurance companies, HMOs, PPOs, and case management programs
Government 3 rd Party Payers: Medicare, Medicaid, Military Health System, & Veterans’ admin
- Large payout
Individual clients & families
Medicare Home Health Criteria & Reimbursement
The patient must:
- Be confined to home or homebound
- Need skilled services (from a nurse or therapist)
- Be under care of a physician
- Receive services under a home health plan of care established and periodically reviewed by a physician
- Have had a face-to-face encounter related to home health condition with a physician or NP
Episode of care: 60 days
Admission: assessment using Outcome and Assessment Information Set (OASIS)
Medicare documentation: OASIS, Medicare plan of care, recertify every 60 days
Medicare-Reimbursed Home Health Care
Prospective payment system
- Episode of care: 60 days
- Payment determined by clinical and functional status at start of care and projected service needs
Start of Care
Referral from physician
Assessment using Outcome and Assessment Information Set (OASIS)
Develop plan of care
Nursing Practice During Home Visits
Contacting patient and/or family to schedule visit
Locating the home
Assessment begins at the curb
Promoting self-management
Collaborating, mobilizing, strengthening, teaching, and solving problems
If it ever becomes unsafe, terminate the visit
- Let someone know
- Also terminate visit if family conflict arises
Selected Nursing Challenges in the Home
Infection control
- Clients
- Home health care team
Medication safety
Risk for falls
Technology at home
Nurse safety
Home Health Nursing Case Management
Nurse as a case manager for each client
Coordinating other professionals and paraprofessionals involved in the client’s care
- PT/OT
Serving as primary contact with client’s physician
Case conferencing with team members (Medicare mandate—every 60 days)
Supervising paraprofessionals
Hospice & Palliative Care
Four types of care:
1) Routine home care with intermittent visits
2) Continuous home care when condition is acute and death is near
3) General inpatient/hospital care for symptom relief
4) Respite care in nursing home of no more than 5 days at a time to relieve family members
Four categories of hospice providers:
1) Home health agencies
2) Hospital-based facilities
3) Skilled nursing facilities
4) Freestanding facilities
Four Foci of Hospice
1) Attention to body, mind, & spirit
2) Death is not a taboo topic
3) Health care tech used w/ discretion
4) Client have a right to truthful discussion & participation in treatment decisions
Medicare Hospice Benefit Requirements
Client must:
- Have a prognosis of 6 months or less to live
- Acknowledge a terminal prognosis
- Choose comfort care instead of life-extending care
- Sign up for comfort-focused hospice benefit
- Waive regular Medicare health services
Hospice Services & Reimbursements
Services
- Coordination of care in all settings
- Clinical and financial case management
Four payment levels
1) Routine home care with intermittent visits
2) Continuous home care for acute condition, imminent death
3) Inpatient hospital care for symptom relief
4) Respite care in a nursing home to relieve family members
When is Hospice Care Appropriate?
When the patient chooses to receive palliative care instead of curative care for a life-limiting or terminal illness
When the physician determines that the patient has a life-expectancy of six months or less if the disease runs its normal course
Can be any age, any illness, as long as above conditions are met
Palliative vs Hospice
Palliative Care
- Symptom Team approach
- Enhance quality of live
- Provided along w/ life-prolonging treatments
Hospice
- Symptom management
- Holistic care
- Team approach
- Enhance quality of life
- Provided in lieu of life-prolonging treatments
- Included as part of Medicare (Hospice Benefit- under Medicare Part A)
Goals of Hospice Care
Provide comfort and relief of physical, emotional, social and spiritual suffering
Promote dignity
Prepare patient/family for death
- Provide a peaceful “good” death as defined by the patient and family
- Empower patient/family to make decisions relating to life closure
