Week 1 Flashcards
The 4Ms in an Age-Friendly Health System
What Matters
Know and align care with each older adult’s specific health outcome goals and care preferences including, but notmlimited to, end-of-life care, and acrosssettings of care
Medication
If medication is necessary, use age-friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care
Mentation
Prevent, identify, treat, and manage delirium across settings of care
Mobility
Ensure that each older adult moves safely every day to maintain function and do What Matters
The Geriatric 5 M’s
The 4Ms in an Age-Friendly Health System Hospital
What Matters
- Ask the older adult What Matters most, document it, and share What Matters across the care team
- Align the care plan with What Matters most
- Review for high-risk medication use and document it
The 4Ms in an Age-Friendly Health System Hospital
Medication
- Deprescribe or avoid high-risk medications, and documentand communicate changes
- Screen for delirium at least every 12 hours and document results
- Ensure sufficient oral hydration
The 4Ms in an Age-Friendly Health System Hospital
Mentation
- Orient to time, place, and situation
- Ensure older adults have their personal adaptive equipment
- Support non-pharmacological sleep
The 4Ms in an Age-Friendly Health System Hospital
Mobility
- Screen for mobility limitations and document the results
- Ensure early, frequent, and safe mobility
Are there more older adult women or men?
women
Ageism is ___________________________________ based on age
stereotyping, prejudice and discrimination
How to avoid ageist terminology
How to use more age positive terminology
How to AVOID AGEIST IMAGERY
Avoid ageist storylines
Sexuality is important to older adults, and they continue to be sexually ________
active
Anatomic and physiologic changes with aging impact _________________ in both men and
women
sexual function
The topic of sex is not routinely raised in office visits; if providers _________ the conversation,
patients are more willing to discuss their sexual concerns.
initiate
______________ is an important aspect of a person’s life, relationships, and overall quality
of life.
Sexuality
Sexuality is impacted by ____________________________________________ factors.
physical, psychological, spiritual, and cultural
__________ describes the characteristic of a relationship comprising feelings of closeness, warmth, and shared life path.
Intimacy
Sexuality plays an important role in a person’s mental and physical health and quality of life throughout the life spectrum. Therefore, providers should__________________ sexuality and sexual concerns with their patients as they age.
continue to discuss
The median age of menopause in the United States is ___ years
51
Low levels of estrogen lead to changes within the genitourinary tract, including
-_____________ of the vagina
-Vaginal ___________
- Changes in the bacterial flora and pH balance
- ___________ of the labia
-Decrease in _____ pad under mons pubis
-Shortening of the vagina
-Vaginal dryness
- Changes in the bacterial flora and pH balance
- Thinning of the labia
-Decrease in fat pad under mons pubis
Changes to male sexual physiology that occur with aging:
-Gradual __________ of physical reaction time to stimulation;
-more ________ is required for arousal, to complete the sexual activity, and to become aroused again for sexual activity.
-Erections may become somewhat less ______ with age, which may be caused by the decrease in elastic fibers, collagen, and smooth muscle in the penis.
-Despite these changes in erections, they usually retain the capacity for intercourse.
-Gradual slowing of physical reaction time to stimulation;
-more time is required for arousal, to complete the sexual activity, and to become aroused again for sexual activity.
-Erections may become somewhat less firm with age, which may be caused by the decrease in elastic fibers, collagen, and smooth muscle in the penis.
-Despite these changes in erections, they usually retain the capacity for intercourse.
ED, the inability to obtain or maintain an erection adequate for intercourse, is the most
prevalent type of sexual dysfunction in older men, ranging from 31% to 44%.
ED at age 40 was ____% and ____% at age 70
Erectile dysfunction, although common, is not a part of __________________
ED, the inability to obtain or maintain an erection adequate for intercourse, is the most
prevalent type of sexual dysfunction in older men, ranging from 31% to 44%.
ED at age 40 was 40% and 70% at age 70
Erectile dysfunction, although common, is not a part of normal aging.
38% of men and 22% of women reported having discussed sex with a physician since the age of ____
50
When sex was raised during the visit, older women were ________ as likely as the physician to have raised the topic
twice
Of those surveyed, ____ % said they would have discussed their sexual concerns had the physician asked.
97
Patient-related barriers to discussion of sexual issues include
_______________ (patients prefer talking with a provider of similar age and sex) and adequate time for the discussion.
Providers appearing ___________
Eighty percent of the women surveyed were willing to return for another appointment specifically dedicated to their sexual concerns
embarrassment (patients prefer talking with a provider of similar age and sex) and adequate time for the discussion.
Providers appearing rushed
Eighty percent of the women surveyed were willing to return for another appointment specifically dedicated to their sexual concerns
Providers are also reluctant to initiate discussions about sexuality. Provider barriers include
-Believing the stereotype that older adults are __________
-Fear of ___________ patients
- Lack of confidence in own skills to discuss sexual issues
-Not having adequate ______ for the discussion
- Provider _______________ with the subject matter
- Provider seeming uninterested or impersonal
-Believing the stereotype that older adults are asexual
-Fear of offending patients
- Lack of confidence in own skills to discuss sexual issues
-Not having adequate time for the discussion
- Provider discomfort with the subject matter
- Provider seeming uninterested or impersonal
To improve discussions of sexuality with patients, providers should:
- Exhibit ___________ demeanor
-Be __________ with subject of sex
-Be understanding and empathetic - Inquire about the sexual function of the patient’s partner
- Raise sexual health topic __________ , as in routine wellness
- Use sexuality/sexual function questionnaire form in routine patient history forms
- Use ______-ended questions
- Exhibit professional demeanor
-Be comfortable with subject of sex
-Be understanding and empathetic - Inquire about the sexual function of the patient’s partner
- Raise sexual health topic routinely, as in routine wellness
- Use sexuality/sexual function questionnaire form in routine patient history forms
- Use open-ended questions
NURSING SENSORY ASSESSMENTS
Ask questions about changes in hearing, vision, sense of smell, and taste, as well as any
numbness and tingling in extremities
Determine whether symptoms occurred suddenly or gradually.
Clarify whether symptoms are unilateral or bilateral.
Ascertain whether sensory conditions interfere with daily function
NURSING ACTIONS AND REFERRALS
Encourage the use of good ___________ in patient rooms. Avoid glare whenever possible.
lighting
NURSING ACTIONS AND REFERRALS
Encourage the use of the patient’s _____________ . Have family provide lighted magnification
if needed. (These are the large magnifiers with a light attached; available for purchase
on a sliding scale at low-vision centers.)
eyeglasses
NURSING ACTIONS AND REFERRALS
Add __________ to the fixtures and electronics in the room if light switches blend into the
wall or faucets blend into the sink. Other low-contrast items in the environment include
remote controls, television sets, and radios
contrast
NURSING ACTIONS AND REFERRALS
Encourage annual _____________ either with an optometrist or ophthalmologist.
eye exams
NURSING ACTIONS AND REFERRALS
Written materials should be provided in at least _________ -point high-contrast fonts
with generous white space to improve visual tracking
14- to 16
NURSING ACTIONS AND REFERRALS
Encourage use of ___________ equipment.
adaptive
Hearing
Assess for cerumen ___________ . Request cerumen softening drops followed by cerumen
removal or ear, nose, and throat consultation
impactions
Hearing
Have at least one pocket __________ on the nursing unit to use with hard-of-hearing
individuals
amplifier
Do not shout at people with hearing impairments, but rather use ______________ of your voice.
lower tones
Hearing
Provide ___________ instructions (use thick, black marker if person is also visually impaired)
written
Encourage use and ensure appropriate care for _________________ : remove batteries at night;
use brush provided to gently clean the tubes to reduce wax accumulation. Before
sending bed linens or clothing to the laundry, determine whether the patient’s hearing
aid is in his or her ear or in its designated location (bedside table or medication cart).
hearing aids
Taste and smell
Take all complaints of _________ or decreased ability to smell or taste seriously. Do not
pass them off to medications or poor dentition.
inability
Taste and smell
Patient teaching should focus on safety issues with _______ of gas and spoiled food.
odors
Taste and smell
Educate seniors to have ____________________ detectors in their homes, date all
food in the refrigerator, and evaluate food with methods other than sense of smell and
taste
smoke and carbon monoxide
Peripheral sensation
Educate every older adult to examine his or her _______ daily, as well as to look inside his or
her shoes before putting them on each day.
feet
Refer diabetics to facilities with certified diabetes educators and ______ care specialists
foot
______ precautions should be in place for all older patients with sensory impairments. Older
adults should avoid falls and injuries to extremities if they have decreased sensation of lower
extremities.
Fall
Annual vision assessment: Medicaid in most states will pay for a new pair of eyeglasses
every _________
2 years.
Given that hearing can change significantly over time, an audiological evaluation for hearing-
impaired older adults every ________ is important.
2 years
Care of the aging senses is an interprofessional endeavor. Nurses who frequently have the
most contact with clients can take the lead in assessing and screening older adults for
decreased ___________ function.
sensory
AGE-ASSOCIATED CARDIOVASCULAR CHANGES
________________ hypertension: Systolic BP 140 mmHg and diastolic BP 90 mmHg
Isolated systolic
Implications of Isolated systolic hypertension
Decreased ________________
cardiac reserve
AGE-ASSOCIATED CHANGES IN THE PULMONARY SYSTEM
- Decreased respiratory __________ strength; stiffer chest wall with reduced compliance
- Diminished ciliary & macrophage activity, drier mucous membranes; decreased _______
reflex - Decreased response to hypoxia and hypercapnia
- Decreased respiratory muscle strength; stiffer chest wall with reduced compliance
- Diminished ciliary & macrophage activity, drier mucous membranes; decreased cough
reflex - Decreased response to hypoxia and hypercapnia
Implications of AGE-ASSOCIATED CHANGES IN THE PULMONARY SYSTEM
- Reduced pulmonary functional reserve
* With exertion: Dyspnea, decreased exercise tolerance - Decreased respiratory excursion and chest/lung expansion with less effective exhalation; respiratory rate of 12 to 24 breaths per minute
- Decreased cough and mucus/foreign matter __________
- Increased risk of ____________ and bronchospasm with airway obstruction
- Reduced pulmonary functional reserve
* With exertion: Dyspnea, decreased exercise tolerance - Decreased respiratory excursion and chest/lung expansion with less effective exhalation; respiratory rate of 12 to 24 breaths per minute
- Decreased cough and mucus/foreign matter clearance
- Increased risk of infection and bronchospasm with airway obstruction
AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS
Decreases in kidney mass, blood flow, GFR (10% decrement/decade after age 30 years);
decreased _________________
drug clearance
AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS
In males, _________ enlargement with risk of BPH
prostate
AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS
Reduced __________ elasticity, muscle tone, capacity
Increased postvoid residual, nocturnal _______ production
Reduced bladder elasticity, muscle tone, capacity
Increased postvoid residual, nocturnal urine production
Implications of AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS
Reduced renal functional __________ ; risk of renal complications in illness
Risk of nephrotoxic __________ and adverse reactions from drugs
Reduced renal functional reserve; risk of renal complications in illness
Risk of nephrotoxic injury and adverse reactions from drugs
Implications of AGE-ASSOCIATED CHANGES IN THE RENAL AND GENITOURINARY SYSTEMS
Risk of volume _____________ (in heart failure), dehydration, hyponatremia (with thiazide
diuretics), hypernatremia (associated with fever), and hyperkalemia (with potassium-
sparing diuretics); reduced excretion of acid load
Increased risk of urinary ___________ , incontinence (not a normal finding), UTI, nocturnal
polyuria; potential for falls
Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), and hyperkalemia (with potassium-sparing diuretics); reduced excretion of acid load
Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria; potential for falls
AGE-ASSOCIATED CHANGES IN THE OROPHARYNGEAL AND GI SYSTEMS
Decreases in strength of muscles of mastication, taste, and thirst perception
Decreased gastric _________ with delayed emptying
Decreases in strength of muscles of mastication, taste, and thirst perception
Decreased gastric motility with delayed emptying
AGE-ASSOCIATED CHANGES IN THE OROPHARYNGEAL AND GI SYSTEMS
Atrophy of protective mucosa
Malabsorption of __________ , vitamins _____and D, folic acid, calcium
Carbs
B12
AGE-ASSOCIATED CHANGES IN THE OROPHARYNGEAL AND GI SYSTEMS
Impaired sensation to ___________
Reduced hepatic reserve; decreased metabolism of drugs
defecate
Implications of AGE-ASSOCIATED CHANGES IN THE OROPHARYNGEAL AND GI SYSTEMS
- Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition
- Gastric changes: Altered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers
- Constipation not a normal finding; risk of fecal incontinence with disease (not in healthy aging)
- Stable liver function tests; risk of adverse drug reactions
- Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition
- Gastric changes: Altered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers
- Constipation not a normal finding; risk of fecal incontinence with disease (not in healthy
aging) - Stable liver function tests; risk of adverse drug reactions
___________: Reduced muscle mass, physical performance, and grip strength associated with aging
Sarcopenia
AGE-ASSOCIATED CHANGES IN THE NERVOUS SYSTEM AND COGNITION
Decrease in ___________ & ___________________
Modifications in cerebral dendrites, glial support cells, synapses
Decrease in neurons and neurotransmitters
Modifications in cerebral dendrites, glial support cells, synapses
AGE-ASSOCIATED CHANGES IN THE NERVOUS SYSTEM AND COGNITION
Compromised _________________
thermoregulation
AGE-ASSOCIATED CHANGES IN THE IMMUNE SYSTEM
immune response dysfunction, reduced efficacy of ____________ and chronic inflammatory state
vaccinations
AGE-ASSOCIATED CHANGES IN THE IMMUNE SYSTEM
Follow ____________________ recommendations for the older adult for pneumococcal
infections, seasonal influenza, zoster, tetnaus, and hepatitis
CDC immunization
________ blunted or absent in very old, frail, or malnourished adults
Fever
_______ is stereotyping, prejudice and discrimination based on age.
Ageism
Gradual _________ of heart valves (resulting in an audible murmur) is a normal physiologic change in older adults
sclerosing
At rest, older adults don’t typically have _________ heart rates to maintain cardiac output
elevated
For older adults, and people of any age frequently, shortness of breath and decreased exercise tolerance with ________ is a normal occurrence
exertion
___________ can harm the kidneys.
You’d want to evaluate your patient’s renal function (GFR, etc.) before sending them to radiology for their exam
IV contrast
For older adults with hearing loss, ______ sound tones can be heard more easily
lower
Safety is a major concern related to sensory deficits, such as taste and smell. Think in terms of not being able to smell _________, or taste foods that have “gone bad”
gas leaks
Screening exams should ideally be conducted prior to _________ for hospitalized older adults, so that appropriate plans/equipment can be available before the patient leaves the hospital
discharge
A majority of older adults continue to express interest in _____________
sexual activity.
Know the physiological changes that could impact the sexual activity of older adult females.
Not all older adult males experience _______________
erectile dysfunction.
Use of phosphodiesterase type 5 inhibitors are contraindicated in patients taking _______
nitrates
interventions to reduce ageist stereotypes and prejudice are often _________.
effective
Recognize media images that perpetuate ageism.
These 3 things increase an older adult’s risk for pneumonia:
diminished ciliary and macrophage activity, ______ mucous membranes, and decreased _______ reflex
diminished ciliary and macrophage activity, drier mucous membranes, and decreased cough reflex
Normal, age-related changes of the immune system/immune responses that you may see in an older adult:
reduced efficacy of _________ , and lack of a ________ during some illnesses.
reduced efficacy of vaccines, and lack of a fever during some illnesses.
To support vision, when considering normal age-related vision changes of the older adult, avoid:
surface ______, poorly lit reading areas, fonts of size ___ or less
surface glares, poorly lit reading areas, fonts of size 12 or less
Core components of the Age-Friendly System:
_________
_________
__________
_________
what Matters, Medication, Mentation, and Mobility.
Age Related Changes
Cardiovascular System –
Arterial wall _____________ and stiffening,
sclerosis,
____________ peripheral pulses
Arterial wall thickening and stiffening,
sclerosis,
diminished peripheral pulses
Age Related Changes
Pulmonary System –
Stiffer chest wall,
_______ mucous membranes,
_________ with exertion,
Decreased respiratory capabilities
Stiffer chest wall,
Drier mucous membranes,
Dyspnea with exertion,
Decreased respiratory capabilities
Age Related Changes
Genitourinary System - Reduced bladder _________ , Enlarged __________
- Reduced bladder elasticity, Enlarged prostate
Age Related Changes
Renal System - Decreased kidney function/ _________________
drug clearing
Age Related Changes
Gastrointestinal System - Decreased _________ , Malabsorption, Impaired ____________
Gastrointestinal System - Decreased motility, Malabsorption, Impaired sensation
Age Related Changes
Nervous System –
Decrease in neurons/neurotransmitters,
Slowed ____________ , _________ disorders
Decrease in neurons/neurotransmitters,
Slowed cognition, Sleep disorders
Age Related Changes
Immune System – Dysfunction, Reduced efficacy of ____________ , ________ absent
Immune System – Dysfunction, Reduced efficacy of vaccinations, Fever absent
Vision
* ________ eye exams, Encourage wearing of glasses
* Use good lighting, avoid glare, add contrast
* 14-16pt font, high ________
- Annual eye exams, Encourage wearing of glasses
- Use good lighting, avoid glare, add contrast
- 14-16pt font, high contrast
Hearing
* Do not shout, use ______ tones
* Pocket amplifier, hearing aides
* Provide _________ instructions
- Do not shout, use lower tones
- Pocket amplifier, hearing aides
- Provide written instructions
Sexual Changes Related to Aging
Male
* Gradual slowing of physical reaction time to stimulation
* Erections may become somewhat less _____ with age
* ED is NOT related to normal aging
* ____ % 65+ interested in sex
- Gradual slowing of physical reaction time to stimulation
- Erections may become somewhat less firm with age
- ED is NOT related to normal aging
- 70% 65+ interested in sex
Sexual Changes Related to Aging
Female – Low levels of ___________
* Shortening of the vagina
* Vaginal dryness
* Changes in the bacterial flora and pH balance
* _________ of the labia
* Decrease in fat pad under mons pubis
* ____ % 65+ interested in sex
Low levels of Estrogen
* Shortening of the vagina
* Vaginal dryness
* Changes in the bacterial flora and pH balance
* Thinning of the labia
* Decrease in fat pad under mons pubis
* 50% 65+ interested in sex
