Older Adults and Family

Question 1

Composition

Answer 1

number of generations that make up the family and various roles that the individuals play inside and outside the family system

Question 2

Governance process

Answer 2

the rules” inside the family; including communication, relationships, behaviors, and power.

Question 3

Organization

Answer 3

refers to interdependent subsystems or “connections” of members as well as their position within the life span

Question 4

External boundaries

Answer 4

can be thought about on a spectrum of closed to open

Question 5

Internal Boundaries

Answer 5

the balance between autonomy and connectedness among the members

Question 6

Managing Essential Family Daily Functions and Tasks

Answer 6

Schedules
Childcare
Laundry
Bills
Food prep
Housekeeping
Managing resources
Healthcare needs

Question 7

What is the key to the family functioning well?

Answer 7

communication

Question 8

Cognitive-perceptual-emotional

Answer 8

denial
withdrawal
crying
anger
bargaining
prayer
humor

Question 9

Behavioral Coping Strategies

Answer 9

seeking emotional support and knowledge
problem solving
distraction or avoidance
pacing
leisure activity
relaxation techniques
alcohol or drug use

Question 10

Resilience

Answer 10

term used to describe the outcome and effectiveness of coping

Question 11

What is the most important physical component to driving?

Answer 11

vision

Driving is 85% visual skill and 15% motor skill

Question 12

Palliative Care

Answer 12

approach that improves the quality of life for patients and families facing life-threatening illness.” (World Health Organization)

Question 13

Hospice

Answer 13

has specific requirements, including the fact that a patient is no longer seeking curative treatments.

Question 14

Medicare Hospice Benefit Qualifications:

Answer 14

Physician must provide certification of a terminal condition with a prognosis of less than 6 months
Patients must certify that they are no longer seeking curative measures for their condition
Patients must be entitled to Medicare Part A services (inpatient)
Begin with 2 initial 90-day periods, which can then be followed by unlimited 60-day periods as long as documentation supports continued need

Question 15

Medicare-certified hospice facilities have an interdisciplinary team (IDT)

Answer 15

Physical (physician and nurse)
Functional (consulting therapists, nurses, and nurse’s aides)
Interpersonal (social workers, psychologists, and counselors)
Spiritual (chaplain, psychologists, and social workers)

Question 16

How often must IDT team meeting occur?

Answer 16

at least every 2 weeks to determine any changes to the current plan of care

Question 17

PT pallative care strategies

Answer 17

rehab light
rehab in reverse
case management
skilled maintenance
supportive care

Question 18

Rehab light

Answer 18

Patient has multiple co-morbid items, maybe a recent treatment and long course of disease. Patient may be experiencing adverse effects of treatment interventions like chemo, surgery, or radiation.
PT might start at once weekly or every other week.
Home exercise program is important
Progress slow over months

Question 19

Rehab in reverse

Answer 19

Utilizing skilled patient and family instruction as a person moves through the transitions from an independently mobile level to a more dependent one as the disease progresses and as strength and balance wane

Question 20

Treatments and visits in rehab in reverse?

Answer 20

Problem solving functional decline
PRN visits might be appropriate for this patient
use of equipment (commode,etc)
proper positioning and skin care management

Question 21

Case management

Answer 21

Providing long-term, ongoing care for challenging and changing conditions.
This model is useful in palliative and hospice care, with patients that are relatively stable, but gradually declining over weeks or months

Question 22

Interventions for case management:

Answer 22

Intervention: instruction to caregivers in providing optimal assistance, updating HEP, outlining problems that might be anticipated.
Monthly visits may be warranted

Question 23

Skilled maintenance:

Answer 23

Under hospice rules, when activities provide for significant quality of life, they are considered skilled care
Ex: safe transfer

Question 24

Supportive Care

Answer 24

Provided throughout the course of care, comprised of the psychosocial support associated with end-of-life process, including physical measures.
PT here can include: pain management techniques or pressure relief

Question 25

Comfort Care Measures

Answer 25

Provide pain relief and comfort
Caring for edema – decreased mobility and statis of position
Manual lymph drainage and other massage techniques
Proper positioning
Range of motion – movement for comfort or for functional ability

Question 26

Pharmacologic Measures for End of Life

Answer 26

nonopioid

opioid

Question 27

Palliative Sedation:

Answer 27

monitored use of medications to relieve refractory and unendurable physical, spiritual, and/ or psychosocial distress for patients with a terminal diagnosis, by inducing varied degrees of unconsciousness

Question 28

Advance directive:

Answer 28

legal document that provides a clear statement of the patient’s desires for care in the event of imminent death (a living will) and the appointment of a person to make decision on their behalf should they become incapacitated (medical power of attorney