Unit 9 Chronic Issues in Geriatric Care Flashcards
What is the model of care for older adults?
Restoring physiological homeostasis
Preventing functional decline
Preventing iatrogenic complications (hospital acquired illnesses)
What is important to assess on admission for the older adults?
Current functional status
How do we prevent functional decline?
Ambulation
Proper nutrition
Encourage independency
Ensure they have proper support (hearing aids, walkers, etc)
What is NOT an expected sign of aging?
Change or decrease in cognitive function is not a normal sign of aging.
What are changes in organs, tissues, and cells as you age?
Decreased peristalsis
Live is less efficient in metabolizing drugs
Visual and hearing impairments
Height decreases
Loss of skeletal muscle and strength
Increased fat
Baroreceptors less responsive
Most things decrease
What is Maslow’s hierarchy of human needs from most to least important?
Physiological (food, water, sex, sleep)
Safety (security of body, employment)
Love/Belonging (family, friends, sexual intimacy)
Esteem (confidence, respect of others, achievement)
Self-Actualization (morality, creativity, spontaneity)
What is Erikson’s stage for the older adult? What does this mean?
Integrity vs Despair
Reviews life, accomplishments, deals with loss and preparation for death
How can you help an older adult through transitions?
Assessment using standardized tools
Encourage reminiscence
Role supplementation (help them maintain relationships)
Creation of healthy environment
Mobilization of resources
What age and older needs a comprehensive assessment?
65 and older
What tools of assessment are used in the geriatric population?
SPICES: for common syndromes of the elderly
- Sleep disorders
- Problems w/eating and feeding
- Incontinence
- Confusion
- Evidence of falls
- Skin breakdown
Mini-Cog: Clock drawling used to detect Dementia
CAM: evidence based tool that recognizes delirium quickly and accurately. Has four features.
Geriatric depression scale: 30 item questionnaire of yes or no questions.
Braden Scale: Predicts pressure ulcer risk. The lower the number the higher the risk.
Hendrich fall risk assessment: specific to geriatric population. quick to administer.
What is the frail elderly criteria? How many does one need to have to be considered frail elderly?
Unintentional weight loss (10lbs or more in a year)
Exhaustion
Weakness (test hand grips to determine)
Decreased function
Slow walking speed
Reduced tolerance for medical interventions
**3 or more = frail elderly
What are geriatric syndromes caused by?
Normal aging
Co-Morbidity and adverse effects of therapeutic interventions
What is the sleep disorder geriatric syndrome? What are some causes and what does it result in?
More daytime naps, less sleep at night (less REM)
Less tolerant to changes (light, temperature, etc)
Causes: diseases: BPH, HF, overactive bladder, pain, meds, etc
Results in: forgetfulness, disorientation, sundowning
What is sun downing syndrome and what is something that should be encouraged?
- PT in the evening becomes disoriented/confused
- Could be from sleep deprivation, not always meds
Encourage being awake in the day time, sleep at night.
What are eating/feeding issues in the elderly?
What does it result in?
- Dietary limitations because of decreased metabolic rate, dyspnea, tooth problems, difficulty swallowing.
- Mealtime is more lonely (encourage family, or someone to eat with PT
- Increase need for Vitamin D, B6, Fiber
Results in: malnutrition, dehydration, vitamin and mineral deficiency
Describe Pain in the elderly.
What does pain contribute to?
- Not a normal sign of aging
- Pain is what the PT says it is
- Need smaller doses of opioids in elderly
- They may not be able to express if cognitively impaired
- Contributes to depression, anxiety, decreased socialization and functional ability
Define the following types of urinary incontinence in the elderly. Function Overflow Stress Urge What are some causes? What does it result in?
Function - PT cannot get to bathroom
Overflow - Not emptying as often
Stress - Cough/sneezing/increased abdominal pressure
Urge - Abdominal contaction
Caused by:
- Pelvic floor laxity
- Constipation
- Diabetes
- Injury
- Infection
- Depression
- Medications
Results in:
-Physical, psychological, social and occupational impairments
What is a better way to ask elderly PT if they are incontinent or continent?
Ask PT, “Do you dribble?”
What are interventions for urinary incontinence?
Encourage q2h emptying
Keegle exercises
Reduce nightly fluid intake
Avoid caffeine/nicotine
Treat infections
Change environment
Describes Dementia syndrome in the elderly. What med should the PT avoid?
- Affects short term then long term memory
- Gets worse with stress
- Assess PT for delusions
- Avoid anti-cholinergic because they cause confusion
ex: exvil, detrol, atrovent
Describe Delirium syndrome.
How is it treated?
Could be from: D rug use E lectrolyte imbalance L ack of drugs (withdrawal or pain) I nfection R eduction sensory input (no hearing aids, glasses) I ntracranial events U rinary incontinence M yocardial infarction
and sleep deprivation.
No treatment itself, treat cause!
What can skin breakdown result in the elderly?
Can add ~ 16 days to hospital stay
Can result in sepsis, cellulitis
What can cause sensory impairments in the elderly? What does it contribute to?
Not having their glasses or hearing aids.
Contributes to falls
When are the elderly most at risk for their health?
Between healthcare transitions
What are the components of the Braden scale?
Sensory perception
Skin moisture
Activity
Mobility
Nutrition
Friction / shear
What are the components of the hendrich fall risk assessment?
Gender
Mental and emotional status
Dizziness
Medications that increase risk
