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EPH > Spring 01b: Elderly and EoL > Flashcards

Spring 01b: Elderly and EoL Flashcards

1
Q

T/F: Geriatric assessments may include those for depression, nutrition, and continence.

A

True

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2
Q

T/F: Geriatric assessments may include those for substance abuse.

A

True

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3
Q

T/F: Geriatric assessments may include those for financials and social supports.

A

True

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4
Q

The (X) assessment is ability to perform everyday tasks and requirements of living. This is a measure of (Y), to determine who is at risk of:

A 
X = functional;
Y = disability

Further decline and death

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5
Q

List the activities of daily living.

A
  1. Toileting/bathing
  2. Eating/feeding
  3. Dressing/grooming
  4. Transferring
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6
Q

Preparing meals is (normal/instrumental) activity of daily living.

A

Instrumental

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7
Q

Shopping is (normal/instrumental) activity of daily living.

A

Instrumental

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8
Q

Bathing is (normal/instrumental) activity of daily living.

A

Normal

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9
Q

Grooming is (normal/instrumental) activity of daily living.

A

Normal

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10
Q

Taking meds is (normal/instrumental) activity of daily living.

A

Instrumental

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11
Q

Dressing is (normal/instrumental) activity of daily living.

A

Normal

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12
Q

Housekeeping is (normal/instrumental) activity of daily living.

A

Instrumental

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13
Q

Functional assessment is used to evaluate need for (skilled/unskilled) services.

A

Both

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14
Q

A home health aide would be considered (skilled/unskilled) service.

A

Unskilled

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15
Q

Physical and occupational would be considered (skilled/unskilled) service.

A

Skilled

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16
Q

Nursing would be considered (skilled/unskilled) service.

A

Skilled

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17
Q

Personal care assistant would be considered (skilled/unskilled) service.

A

Unskilled

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18
Q

T/F: Functional assessment is used to plan for safe discharge/post-discharge care from hospital.

A

True

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19
Q

(X) is the ADL that may be considered “straw that breaks the camel’s back”. It pushes a patient from a (home health agency/nursing home) into a (home health agency/nursing home).

A

X = Incontinence/toileting

Home health agency;
Nursing home

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20
Q

T/F: ADL’s are typically lost simultaneously.

A

False - in succession (bathing, dressing, then walking)

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21
Q

Which fraction of Americans have dementia at time of death?

A

1/3

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22
Q

Dementia is (over/under)-diagnosed.

A

Under-diagnosed

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23
Q

T/F: Dementia is the only cause of death in top 10 that can’t be prevented. But can be cured/slowed.

A

False - can’t be prevented, cured, or slowed

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24
Q

What’s the gold standard for cognitive assessment?

A

Many tools, no gold standard

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25
Q

Tools for cognitive assessment used in primary care take about (X) minutes and are free from (Y) bias.

A 
X = 5
Y = cultural, educational, language
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26
Q

List the most appropriate cognitive assessments tools for primary care.

A
  1. Mini-cog
  2. MIS (memory impairment screen)
  3. GPAC (GP Assessment of Cognition)
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27
Q

Late-life depression occurs after age (X).

A

X = 60

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28
Q

T/F: Depression in late life most often presents with low mood.

A

False - mainly irritability, somatic complaints or anxiety

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29
Q

PHQ-2 and PHQ-9 are validated screening tools for:

A

Depression

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30
Q

Community-based services for the elderly provide (skilled/non-skilled) services.

A

Non-skilled

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31
Q

In 2016, adult day care cost about (X) per day. Which category of service does this fall under?

A

X = $70

Community-based services

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32
Q

On average in MA, assisted living cost about (X) per year. Which category of service does this fall under?

A

X = $64,000

Community-based

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33
Q

On average in US, nursing cost about (X) per year. But some in MA can be as high as (Y) per year.

A 
X = $90,000
Y = $144,000
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34
Q

T/F: The most disabled elderly are in home/hopsice, then nursing home.

A

False - nursing home, followed by home/hospice

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35
Q

T/F: Majority of nursing home residents have deficits in all ADLs.

A

True

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36
Q

AD affects what fraction of nursing home residents? And hospice patients?

A

Over 1/2 in NH and almost 1/2 of hospice patients

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37
Q

Depression affects what fraction of nursing home residents?

A

Almost 1/2

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38
Q

T/F: Diabetes is a major contributor for disability and long-term care services.

A

True

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39
Q

Largest payer of long-term care services is (X), paying (Y)% of LTC costs.

A 
X = medicaid
Y = 40
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40
Q

Medicaid LTC services: largely paid for by (X) and administered by (Y).

A 
X = federal government
Y = states
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41
Q

T/F: there’s an income requirement for LTC funding through medicaid.

A

True

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42
Q

Eligibility for long-term nursing home care (MA) through medicaid: can’t have more than $(X) in assets except:

A

X = 2000

  1. Personal possessions
  2. Home (under $786,000)
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43
Q

Medicaid eligibility for LT nursing home care in MA has (X) penalty with (Y)-month look-back for (small/large) money transfers.

A 
X = transfer
Y = 60

Large

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44
Q

Exceptions to transfer penalty in medicaid eligibility for nursing home care.

A
  1. Spouse

2. Disabled or “caretaker” children

45
Q

Medicaid eligibility age requirement for LT home care services (MA): must be (X) years or older unless (Y).

A 
X = 60
Y = has AD
46
Q

Medicaid eligibility requirement for LT home care services (MA): must have (X) number of ADL impairments.

A

X = more than 2

47
Q

Second-largest payer of long-term care services is (X), paying (Y)% of LTC costs.

A 
X = medicare;
Y = 21
48
Q

Medicare eligibility age requirement for LTC services: must be (X) years or older unless (Y).

A 
X = 65
Y  = has disabilities
49
Q

T/F: Long-term post-hospitalization care (rehab/nursing facilities) covered by Medicare.

A

False - short-term only

50
Q

T/F: Hospice for end-of-life care covered by Medicare.

A

True

51
Q

T/F: community-based skilled care services for elderly covered by Medicare.

A

True - short-term only

52
Q

Medicare requirements for skilled nursing/rehabilitation include (X)-day inpatient stay and a (Y) condition.

A 
X = 3;
Y = hospital-related
53
Q

T/F: Medicare requirements for skilled nursing/rehabilitation includes doctor’s order.

A

True

54
Q

T/F: Medicare requirements for skilled nursing/rehabilitation include OOP expenses, starting day 10.

A

False - starting day 21

55
Q

Medicare requirements for skilled nursing/rehabilitation include full costs via OOP starting which day?

A

If over 100 days

56
Q

Third-largest payer of long-term care services is (X), paying (Y)% of LTC costs.

A 
X = Out-of-pocket
Y = 15
57
Q

MOLST, aka (X), is (medical order/legal document) that specifies the desired (Y).

A

X = MA Order for Life-sustaining Treatment
Medical order;
Y = medical care for LST (life-sustaining treatment)

58
Q

Life-sustaining treatment includes:

A
  1. CPR/mechanical ventilators
  2. Artificial tube
  3. ICU/hospitalizations
  4. Medications/dialysis
59
Q

T/F: LST, even if costly, is considered effective if it meets patient’s cultural/religious needs.

A

True

60
Q

T/F: The success of CPR is often underrated.

A

False - overrated

61
Q

(X)% of hospitalized patients survive CPR and are discharged alive.

A

X = 5-17

62
Q

(X) are (written/verbal) plans made by adults about how they want their healthcare decisions made if they should become unable to make decisions for themselves.

A

X = advanced directives;

Can be written or verbal

63
Q

(X) is a written advance directive in which a person appoints another person, called (Y), to make health decisions should the person making the appointment become incapacitated.

A 
X = Power of Attorney for Healthcare
Y = health care proxy
64
Q

T/F: Proxies can reverse decisions made by patient.

A

True

65
Q

In 2014, the majority of patients received hospice care at (hospital/inpatient facility/residence).

A

Residence (59%)

66
Q

Hospice makes (short/long)-term inpatient care available under which conditions?

A

Short-term;

  1. Pain/symptoms too difficult to manage at home
  2. Caregiver needs respite time
67
Q

T/F: Hospice can provide special services (i.e. therapy), but no drugs, medical supplies and equipment.

A

False - provides all of that

68
Q

In PACE, aka (X), who provides care? Funding comes from (Y).

A

X = Program for All-inclusive Care for Elderly;
Multi-disciplinary teams;
Y = Medicare and Medicaid (monthly capitations)

69
Q

T/F: PACE program assumes full financial risk.

A

True - capitated payments

70
Q

T/F: PACE program has reduced hospitalization, nursing home, and Medicaid costs.

A

False - not medicaid costs

71
Q

PACE provided to (medicaid/medicare) eligible elders who are also (X).

A

Medicaid;

X = eligible for nursing home

72
Q

The PSDA, aka (X), of 1991 required that:

A

X = Patient Self-Determination Act

All health institutions inquire (upon admission) whether patient has advance directive

73
Q

T/F: Since PSDA of 1991, over 80% of US adults have advance directive.

A

False - only about 30%!

74
Q

T/F: During advanced care planning, you should document the conversation.

A

True

75
Q

T/F: Most patients using hospice are minorities.

A

False - white (80%)

76
Q

T/F: Most patients using hospice are non-cancer patients.

A

True (63%)

77
Q

Top 2 non-cancer diagnoses for patients using hospice.

A

AD (15%) and CVD (15%)

78
Q

To be eligible for hospice, patient must be eligible for (medicare/medicaid/private insurance) and also have:

A

Any of those;

Certification from 2 doctors that he/she is terminally ill (6-month life expectancy)

79
Q

T/F: To be eligible for hospice, patient must sign paper, agreeing to forego curative care therapies.

A

True

80
Q

T/F: If patient on hospice lives past 6 months, he/she is no longer eligible for hospice care.

A

False - simply needs to get recertified every 6 months

81
Q

Patient on hospice via Medicare pays (X) for general hospice care, copayments for (Y), and (Z)% cost for inpatient respite care.

A 
X = $0
Y = prescription drugs
Z = 5
82
Q

T/F: Patient receiving hospice (via medicare) at nursing home has to pay the room and board for nursing home.

A

True

83
Q

About what percent of hospice patients stay for under 1 week?

A

35%

84
Q

About what percent of hospice patients stay for over 180 days?

A

10%

85
Q

Length of stay at non-profit hospice is (greater/equal/less) compared to that at for-profit hospice.

A

Less

86
Q

T/F: Almost 80% of medicare beneficiaries use hospice care.

A

False - only 47%

87
Q

Vast majority of hospice profits come from:

A

US govt (medicare) - about 90%

88
Q

Concurrent care model aims to:

A

Allow option to receive hospice and curative services

89
Q

T/F: Two barriers to palliative care is lack of demand and lack of public knowledge.

A

True

90
Q

T/F: One barrier to palliative care is lack of funding, despite adequate workforce in the field.

A

False - lack of adequate workforce

91
Q

Define a patient’s “capacity”.

A

Ability to understand the nature and consequences of a decision (benefits, risks, alternatives); and to reach informed decision

92
Q

T/F: Patient capacity is needed for autonomy.

A

True

93
Q

T/F: Patient capacity goes hand-in-hand with competency.

A

False

94
Q

The act of ending of life to relieving suffering (physician administers the means of death).

A

Euthanasia

95
Q

Which states have legalized euthanasia?

A

None!

96
Q

The act of knowingly/intentionally providing a person with the knowledge/means required to commit suicide.

A

PAS

97
Q

Which states have legalized PAS?

A

Oregon, Washington, Vermont, CA and CO

And Montana likely wouldn’t prosecute physicians

98
Q

Giving pain medication with the intent of relieving suffering, despite knowing that the dose may also hasten death.

A

The Double Effect

99
Q

The distinction between refusal for or withdrawal of life support is the patient’s (X).

A

X = capacity at the time

100
Q

A patient may lack capacity if he/she is impaired by:

A

Medication, dementia, or mental illness

101
Q

Over (X)% of people with chronic illness say they want to avoid ICU/hospitalization at end of life.

A

X = 80

102
Q

In US, almost (X)% of people die in hospital, nursing home, or other long term facility.

A

X = 70

103
Q

(X)% of US postulation and (Y)% of physicians have advance directives.

A 
X = 20-30
Y = 65
104
Q

Document completed by patient that’s intended to guide medical care in case patient loses capacity.

A

Advance Directives

105
Q

Document patient completes assigning person to make health care decisions in case of incapacity.

A

Health Care Proxy

106
Q

Written document directing care in event of loss of capacity.

A

Living will

107
Q

The (X) document helps guide decisions made by (Y) in event that patient loses capacity. But in MA, (X/Y) can override the directive of (X/Y).

A 
X = living will
Y = health care proxy

Health care proxy can override living will directive

108
Q

Legal document where patient assigns person to handle financial affairs in event of incapacity.

A

Durable power of attorney

109
Q

T/F: patients with capacity can refuse treatment, even if it leads to their deaths.

A

True

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