Older Adults and Family Flashcards
Composition
number of generations that make up the family and various roles that the individuals play inside and outside the family system
Governance process
the rules” inside the family; including communication, relationships, behaviors, and power.
Organization
refers to interdependent subsystems or “connections” of members as well as their position within the life span
External boundaries
can be thought about on a spectrum of closed to open
Internal Boundaries
the balance between autonomy and connectedness among the members
Managing Essential Family Daily Functions and Tasks
Schedules Childcare Laundry Bills Food prep Housekeeping Managing resources Healthcare needs
What is the key to the family functioning well?
communication
Cognitive-perceptual-emotional
denial withdrawal crying anger bargaining prayer humor
Behavioral Coping Strategies
seeking emotional support and knowledge problem solving distraction or avoidance pacing leisure activity relaxation techniques alcohol or drug use
Resilience
term used to describe the outcome and effectiveness of coping
What is the most important physical component to driving?
vision
Driving is 85% visual skill and 15% motor skill
Palliative Care
approach that improves the quality of life for patients and families facing life-threatening illness.” (World Health Organization)
Hospice
has specific requirements, including the fact that a patient is no longer seeking curative treatments.
Medicare Hospice Benefit Qualifications:
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
Medicare-certified hospice facilities have an interdisciplinary team (IDT)
Physical (physician and nurse)
Functional (consulting therapists, nurses, and nurse’s aides)
Interpersonal (social workers, psychologists, and counselors)
Spiritual (chaplain, psychologists, and social workers)
How often must IDT team meeting occur?
at least every 2 weeks to determine any changes to the current plan of care
PT pallative care strategies
rehab light rehab in reverse case management skilled maintenance supportive care
Rehab light
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
Rehab in reverse
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
Treatments and visits in rehab in reverse?
Problem solving functional decline
PRN visits might be appropriate for this patient
use of equipment (commode,etc)
proper positioning and skin care management
Case management
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
Interventions for case management:
Intervention: instruction to caregivers in providing optimal assistance, updating HEP, outlining problems that might be anticipated.
Monthly visits may be warranted
Skilled maintenance:
Under hospice rules, when activities provide for significant quality of life, they are considered skilled care
Ex: safe transfer
Supportive Care
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
Comfort Care Measures
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
Pharmacologic Measures for End of Life
nonopioid
opioid
Palliative Sedation:
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
Advance directive:
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
