Spring 01b: Elderly and EoL Flashcards
T/F: Geriatric assessments may include those for depression, nutrition, and continence.
True
T/F: Geriatric assessments may include those for substance abuse.
True
T/F: Geriatric assessments may include those for financials and social supports.
True
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:
X = functional; Y = disability
Further decline and death
List the activities of daily living.
- Toileting/bathing
- Eating/feeding
- Dressing/grooming
- Transferring
Preparing meals is (normal/instrumental) activity of daily living.
Instrumental
Shopping is (normal/instrumental) activity of daily living.
Instrumental
Bathing is (normal/instrumental) activity of daily living.
Normal
Grooming is (normal/instrumental) activity of daily living.
Normal
Taking meds is (normal/instrumental) activity of daily living.
Instrumental
Dressing is (normal/instrumental) activity of daily living.
Normal
Housekeeping is (normal/instrumental) activity of daily living.
Instrumental
Functional assessment is used to evaluate need for (skilled/unskilled) services.
Both
A home health aide would be considered (skilled/unskilled) service.
Unskilled
Physical and occupational would be considered (skilled/unskilled) service.
Skilled
Nursing would be considered (skilled/unskilled) service.
Skilled
Personal care assistant would be considered (skilled/unskilled) service.
Unskilled
T/F: Functional assessment is used to plan for safe discharge/post-discharge care from hospital.
True
(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).
X = Incontinence/toileting
Home health agency;
Nursing home
T/F: ADL’s are typically lost simultaneously.
False - in succession (bathing, dressing, then walking)
Which fraction of Americans have dementia at time of death?
1/3
Dementia is (over/under)-diagnosed.
Under-diagnosed
T/F: Dementia is the only cause of death in top 10 that can’t be prevented. But can be cured/slowed.
False - can’t be prevented, cured, or slowed
What’s the gold standard for cognitive assessment?
Many tools, no gold standard
Tools for cognitive assessment used in primary care take about (X) minutes and are free from (Y) bias.
X = 5 Y = cultural, educational, language
List the most appropriate cognitive assessments tools for primary care.
- Mini-cog
- MIS (memory impairment screen)
- GPAC (GP Assessment of Cognition)
Late-life depression occurs after age (X).
X = 60
T/F: Depression in late life most often presents with low mood.
False - mainly irritability, somatic complaints or anxiety
PHQ-2 and PHQ-9 are validated screening tools for:
Depression
Community-based services for the elderly provide (skilled/non-skilled) services.
Non-skilled
In 2016, adult day care cost about (X) per day. Which category of service does this fall under?
X = $70
Community-based services
On average in MA, assisted living cost about (X) per year. Which category of service does this fall under?
X = $64,000
Community-based
On average in US, nursing cost about (X) per year. But some in MA can be as high as (Y) per year.
X = $90,000 Y = $144,000
T/F: The most disabled elderly are in home/hopsice, then nursing home.
False - nursing home, followed by home/hospice
T/F: Majority of nursing home residents have deficits in all ADLs.
True
AD affects what fraction of nursing home residents? And hospice patients?
Over 1/2 in NH and almost 1/2 of hospice patients
Depression affects what fraction of nursing home residents?
Almost 1/2
T/F: Diabetes is a major contributor for disability and long-term care services.
True
Largest payer of long-term care services is (X), paying (Y)% of LTC costs.
X = medicaid Y = 40
Medicaid LTC services: largely paid for by (X) and administered by (Y).
X = federal government Y = states
T/F: there’s an income requirement for LTC funding through medicaid.
True
Eligibility for long-term nursing home care (MA) through medicaid: can’t have more than $(X) in assets except:
X = 2000
- Personal possessions
- Home (under $786,000)
Medicaid eligibility for LT nursing home care in MA has (X) penalty with (Y)-month look-back for (small/large) money transfers.
X = transfer Y = 60
Large
Exceptions to transfer penalty in medicaid eligibility for nursing home care.
- Spouse
2. Disabled or “caretaker” children
Medicaid eligibility age requirement for LT home care services (MA): must be (X) years or older unless (Y).
X = 60 Y = has AD
Medicaid eligibility requirement for LT home care services (MA): must have (X) number of ADL impairments.
X = more than 2
Second-largest payer of long-term care services is (X), paying (Y)% of LTC costs.
X = medicare; Y = 21
Medicare eligibility age requirement for LTC services: must be (X) years or older unless (Y).
X = 65 Y = has disabilities
T/F: Long-term post-hospitalization care (rehab/nursing facilities) covered by Medicare.
False - short-term only
T/F: Hospice for end-of-life care covered by Medicare.
True
T/F: community-based skilled care services for elderly covered by Medicare.
True - short-term only
Medicare requirements for skilled nursing/rehabilitation include (X)-day inpatient stay and a (Y) condition.
X = 3; Y = hospital-related
T/F: Medicare requirements for skilled nursing/rehabilitation includes doctor’s order.
True
T/F: Medicare requirements for skilled nursing/rehabilitation include OOP expenses, starting day 10.
False - starting day 21
Medicare requirements for skilled nursing/rehabilitation include full costs via OOP starting which day?
If over 100 days
Third-largest payer of long-term care services is (X), paying (Y)% of LTC costs.
X = Out-of-pocket Y = 15
MOLST, aka (X), is (medical order/legal document) that specifies the desired (Y).
X = MA Order for Life-sustaining Treatment
Medical order;
Y = medical care for LST (life-sustaining treatment)
Life-sustaining treatment includes:
- CPR/mechanical ventilators
- Artificial tube
- ICU/hospitalizations
- Medications/dialysis
T/F: LST, even if costly, is considered effective if it meets patient’s cultural/religious needs.
True
T/F: The success of CPR is often underrated.
False - overrated
(X)% of hospitalized patients survive CPR and are discharged alive.
X = 5-17
(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.
X = advanced directives;
Can be written or verbal
(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.
X = Power of Attorney for Healthcare Y = health care proxy
T/F: Proxies can reverse decisions made by patient.
True
In 2014, the majority of patients received hospice care at (hospital/inpatient facility/residence).
Residence (59%)
Hospice makes (short/long)-term inpatient care available under which conditions?
Short-term;
- Pain/symptoms too difficult to manage at home
- Caregiver needs respite time
T/F: Hospice can provide special services (i.e. therapy), but no drugs, medical supplies and equipment.
False - provides all of that
In PACE, aka (X), who provides care? Funding comes from (Y).
X = Program for All-inclusive Care for Elderly;
Multi-disciplinary teams;
Y = Medicare and Medicaid (monthly capitations)
T/F: PACE program assumes full financial risk.
True - capitated payments
T/F: PACE program has reduced hospitalization, nursing home, and Medicaid costs.
False - not medicaid costs
PACE provided to (medicaid/medicare) eligible elders who are also (X).
Medicaid;
X = eligible for nursing home
The PSDA, aka (X), of 1991 required that:
X = Patient Self-Determination Act
All health institutions inquire (upon admission) whether patient has advance directive
T/F: Since PSDA of 1991, over 80% of US adults have advance directive.
False - only about 30%!
T/F: During advanced care planning, you should document the conversation.
True
T/F: Most patients using hospice are minorities.
False - white (80%)
T/F: Most patients using hospice are non-cancer patients.
True (63%)
Top 2 non-cancer diagnoses for patients using hospice.
AD (15%) and CVD (15%)
To be eligible for hospice, patient must be eligible for (medicare/medicaid/private insurance) and also have:
Any of those;
Certification from 2 doctors that he/she is terminally ill (6-month life expectancy)
T/F: To be eligible for hospice, patient must sign paper, agreeing to forego curative care therapies.
True
T/F: If patient on hospice lives past 6 months, he/she is no longer eligible for hospice care.
False - simply needs to get recertified every 6 months
Patient on hospice via Medicare pays (X) for general hospice care, copayments for (Y), and (Z)% cost for inpatient respite care.
X = $0 Y = prescription drugs Z = 5
T/F: Patient receiving hospice (via medicare) at nursing home has to pay the room and board for nursing home.
True
About what percent of hospice patients stay for under 1 week?
35%
About what percent of hospice patients stay for over 180 days?
10%
Length of stay at non-profit hospice is (greater/equal/less) compared to that at for-profit hospice.
Less
T/F: Almost 80% of medicare beneficiaries use hospice care.
False - only 47%
Vast majority of hospice profits come from:
US govt (medicare) - about 90%
Concurrent care model aims to:
Allow option to receive hospice and curative services
T/F: Two barriers to palliative care is lack of demand and lack of public knowledge.
True
T/F: One barrier to palliative care is lack of funding, despite adequate workforce in the field.
False - lack of adequate workforce
Define a patient’s “capacity”.
Ability to understand the nature and consequences of a decision (benefits, risks, alternatives); and to reach informed decision
T/F: Patient capacity is needed for autonomy.
True
T/F: Patient capacity goes hand-in-hand with competency.
False
The act of ending of life to relieving suffering (physician administers the means of death).
Euthanasia
Which states have legalized euthanasia?
None!
The act of knowingly/intentionally providing a person with the knowledge/means required to commit suicide.
PAS
Which states have legalized PAS?
Oregon, Washington, Vermont, CA and CO
And Montana likely wouldn’t prosecute physicians
Giving pain medication with the intent of relieving suffering, despite knowing that the dose may also hasten death.
The Double Effect
The distinction between refusal for or withdrawal of life support is the patient’s (X).
X = capacity at the time
A patient may lack capacity if he/she is impaired by:
Medication, dementia, or mental illness
Over (X)% of people with chronic illness say they want to avoid ICU/hospitalization at end of life.
X = 80
In US, almost (X)% of people die in hospital, nursing home, or other long term facility.
X = 70
(X)% of US postulation and (Y)% of physicians have advance directives.
X = 20-30 Y = 65
Document completed by patient that’s intended to guide medical care in case patient loses capacity.
Advance Directives
Document patient completes assigning person to make health care decisions in case of incapacity.
Health Care Proxy
Written document directing care in event of loss of capacity.
Living will
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).
X = living will Y = health care proxy
Health care proxy can override living will directive
Legal document where patient assigns person to handle financial affairs in event of incapacity.
Durable power of attorney
T/F: patients with capacity can refuse treatment, even if it leads to their deaths.
True
