Week 2

Question 1

Globally, in 2020, 2/3 of older adults live in ________ income countries

Answer 1

middle

Question 2

by 2030, 1/__ people will be age 60+

Answer 2

6

Question 3

by 2030, 1/6 people will be age 60+

By 2050, this will increase to

Answer 3

1/5 people

Question 4

WHO 4 areas for action

1. _________ how we think, feel and act towards age and ageing;
2. ensure that communities _________ the abilities of older people;
3. deliver person-centred integrated care and primary health services that are __________ to older people;
4. provide access to _______-term care for older people who need it.

Answer 4

1. change how we think, feel and act towards age and ageing;
2. ensure that communities foster the abilities of older people;
3. deliver person-centred integrated care and primary health services that are responsive to older people;
4. provide access to long-term care for older people who need it.

Question 5

A decade of action creates __________ to meet the needs and rights of older persons and to generate transformative change

Answer 5

urgency

Question 6

Healthy ageing is “the process of developing and maintaining the _______________ that enables well-being in older age”.

Answer 6

functional ability

Question 7

____________ ability reflects a person’s physical and mental capacities, the environments he or she inhabits and the ways in which people interact with their environment

Answer 7

Functional

Question 8

Healthy ageing is about creating the opportunities that enable people to be and do what they _______ throughout their lives.

Answer 8

value

Question 9

Being free of disease or impairment is not a requirement for healthy ageing; many older people have one or more health conditions that, when well managed in an enabling environment, have little influence on their __________

Rather, __________ functional ability is the key to healthy ageing.

Answer 9

Being free of disease or impairment is not a requirement for healthy ageing; many older people have one or more health conditions that, when well managed in an enabling environment, have little influence on their well-being.

Rather, optimizing functional ability is the key to healthy ageing.

Question 10

Functional ability enables people to be and to do what they have reason to _______

Answer 10

value

Question 11

Intrinsic capacity comprises all the physical and mental capacities that a person can draw on.

Important domains include a person’s:
1. __________ capacity (physical movement);
2. _________ capacity (such as vision and hearing);
3. ________ (energy and balance);
4. __________ ; and
5. ___________ capacity.

Answer 11

Intrinsic capacity comprises all the physical and mental capacities that a person can draw on.

Important domains include a person’s:
1. locomotor capacity (physical movement);
2. sensory capacity (such as vision and hearing);
3. vitality (energy and balance);
4. cognition; and
5. psychological capacity.

Question 12

_____________ are where people live and conduct their lives. Environments shape what older people with a given level of intrinsic capacity can be and do.

Environments shape what older people with a given level of intrinsic capacity can be and do.
Environments include the home, community and broader society, and all the factors within
them.

Answer 12

Environments are where people live and conduct their lives. Environments shape what older people with a given level of intrinsic capacity can be and do.

Environments shape what older people with a given level of intrinsic capacity can be and do.
Environments include the home, community and broader society, and all the factors within
them.

Question 13

ENVIRONMENTS Key domains relate to:

1. products, equipment and technology that facilitate movement, sight, memory and daily
   functioning;
2. the natural or built environment;
3. emotional support, assistance and relationships provided by other people and animals;
4. attitudes (as these influence behaviour both negatively and positively); and more broadly
5. services, systems and policies that may or may not contribute to enhanced functioning at
   older ages

Answer 13

1. products, equipment and technology that facilitate movement, sight, memory and daily
   functioning;
2. the natural or built environment;
3. emotional support, assistance and relationships provided by other people and animals;
4. attitudes (as these influence behaviour both negatively and positively); and more broadly
5. services, systems and policies that may or may not contribute to enhanced functioning at
   older ages

Question 14

Most determinants of healthy ageing can be shaped by _______

Answer 14

policy

Question 15

THREE COMPONENTS OF HEALTHY AGING

Answer 15

functional ability
intrinsic capacity
environments

Question 16

Healthy ageing looks at the whole person in their unique __________

Answer 16

environment

Question 17

_____________ status of individuals describes the capacity and performance of safe ADL and
IADL and is a sensitive indicator of health or illness in older adults.

It is, therefore, a critical nursing assessment

Answer 17

Functional status of individuals describes the capacity and performance of safe ADL and
IADL and is a sensitive indicator of health or illness in older adults.

It is, therefore, a critical nursing assessment

Question 18

Some functional decline may be prevented or ameliorated with prompt and aggressive
______________________ (e.g., ambulation, toileting schedules, enhanced communication, adaptive equipment, attention to medications and dosages, and management of pain)

Answer 18

nursing intervention

Question 19

Functional decline is often the initial symptom of acute illness such as infections (e.g., pneumonia and UTI). These declines are usually __________ and require medical evaluation

Answer 19

reversible

Question 20

Risk factors for functional ____________ include frailty injuries, acute illness, medication side effects, pain, depression, malnutrition, decreased mobility, prolonged bed rest (including the use of physical restraints), prolonged use of Foley catheters, and changes in environment or routines

Answer 20

decline

Question 21

Additional _____________ of functional decline include loss of independence, falls, incontinence, malnutrition, decreased socialization, depression, and increased risk for long-
term institutionalization and depression

Answer 21

complications

Question 22

Functional status ___________ assists patients and their families in planning future care needs
post hospitalization, such as short-term skilled care, assisted living, home care, and need for
community services

Answer 22

evaluation

Question 23

Comprehensive functional assessment of older adults includes _________________________ of
basic ADL, social activities, or IADL, the assistance needed to accomplish these tasks, and
sensory ability, pain level, cognition, and capacity to ambulate

Answer 23

independent performance

Question 24

Older adults may view their health in terms of how well they can function rather than in
terms of disease alone. __________ should be emphasized as well as needs for assistance

Answer 24

Strengths

Question 25

Strategies to maximize functional status and to prevent decline

Maintain individual’s daily ____________.
Help to maintain physical, cognitive, and social function through physical activity and ___________.
Encourage ambulation, encourage the individual to get out of bed for meals, allow flexible visitation, including pets, and encourage reading the newspaper.

Answer 25

Maintain individual’s daily routine.
Help to maintain physical, cognitive, and social function through physical activity and socialization.
Encourage ambulation, encourage the individual to get out of bed for meals, allow flexible visitation, including pets, and encourage reading the newspaper.

Question 26

Strategies to maximize functional status and to prevent decline

Educate older adults, family, and formal caregivers on the value of _____________ functioning and the consequences of functional decline ; increased risk for complications such as malnutrition, falls, hospital readmissions, increased likelihood of being discharged to a nursing home setting; increased mortality ; and decreased functional recovery, ultimately decreasing quality of life

Answer 26

Educate older adults, family, and formal caregivers on the value of independent functioning and the consequences of functional decline ; increased risk for complications such as malnutrition, falls, hospital readmissions, increased likelihood of being discharged to a nursing home setting; increased mortality ; and decreased functional recovery, ultimately decreasing quality of life

Question 27

Strategies to maximize functional status and to prevent decline

Encourage activity, including routine ____________, range of motion, and ambulation to maintain activity, flexibility, and function

Answer 27

Encourage activity, including routine exercise, range of motion, and ambulation to
maintain activity, flexibility, and function

Question 28

Strategies to maximize functional status and to prevent decline

Assess and treat for ________

Answer 28

pain

Question 29

Strategies to maximize functional status and to prevent decline

Design environments with ___________; wide doorways; raised toilet seats; shower _______;
enhanced lighting; low beds; and chairs of various types and height, including recliners
and rocking chairs

Answer 29

Design environments with handrails; wide doorways; raised toilet seats; shower seats;
enhanced lighting; low beds; and chairs of various types and height, including recliners
and rocking chairs

Question 30

EXPECTED OUTCOMES

Patients can
1. Maintain ______level of ADL and ambulation.
2. Make necessary ________________ to maintain safety and independence, including assistive
devices and environmental adaptations.
3. Strive to attain highest quality of life despite low functional level.

Answer 30

1. Maintain safe level of ADL and ambulation.
2. Make necessary adaptations to maintain safety and independence, including assistive
   devices and environmental adaptations.
3. Strive to attain highest quality of life despite low functional level.

Question 31

Institution will experience - System-wide incorporation of functional assessment into __________ assessments

Answer 31

routine

Question 32

Functional decline is a common complication in ___________ older adults, even in those with
good baseline function

Answer 32

hospitalized

Question 33

Loss of __________ function is associated with poor long-term outcomes, including increased
likelihood of being discharged to a nursing home setting, increased rehabilitation costs, and decreased functional recovery, The immobility associated with functional decline results in infections, pressure ulcers, falls, a persistent decline in function and physical activity, and nonelective rehospitalizations

Answer 33

physical

Question 34

Functional decline may result from the acute illness and can begin before admission and continue after discharge. ________ function serves as a useful benchmark when developing discharge goals

Answer 34

Baseline

Question 35

Interprofessional rounds support promotion of function by addressing functional
assessment (baseline and current), evaluate potentially restrictive devices and agents, and
yield a plan for progressive __________

Answer 35

mobility

Question 35

FOCUSED CARE INTERVENTIONS

Well-defined _______ , including areas of accountability for assessment and follow-through
for function-promoting activities

Answer 35

roles

Question 35

Physical design

Toilets, beds, and chairs at appropriate _________ to promote safe transfers and function

Adequate __________ , nonglare flooring, door levers, and handrails (including in the patient
room)

Policy on storage of glasses and hearing aids, access to sensory aids, hearing amplifiers
and magnifiers

Answer 35

Toilets, beds, and chairs at appropriate height to promote safe transfers and function

Adequate lighting, nonglare flooring, door levers, and handrails (including in the patient
room)

Policy on storage of glasses and hearing aids, access to sensory aids, hearing amplifiers
and magnifiers

Question 35

Policy and procedures to support function promotion

1. Protocols that minimize __________ effects of selected procedures (e.g., urinary catheterization) and medications (e.g., sedative–hypnotic agents) contribute to positive functional outcomes
2. Supporting policies: identification and storage of sensory devices (e.g., glasses, hearing aids/amplifiers), mobility devices, and other ___________ devices
3. ___________ policies that address the continuous plan for function promotion

Answer 35

1. Protocols that minimize adverse effects of selected procedures (e.g., urinary catheterization) and medications (e.g., sedative–hypnotic agents) contribute to positive functional outcomes
2. Supporting policies: identification and storage of sensory devices (e.g., glasses, hearing aids/amplifiers), mobility devices, and other assistive devices
3. Discharge policies that address the continuous plan for function promotion

Question 35

Patients will:
1. Be discharged functioning at their ___________ level

Answer 35

maximum

Question 35

Atypical Presentation Risk Factors
* Over age ___ in particular
* Multiple co-morbidities
* Multiple ____________
* Cognitive or functional impairment

Answer 35

• Over age 85 in particular
• Multiple co-morbidities
• Multiple medications
• Cognitive or functional impairment

Question 35

Clinical assessment and interventions

1. Assessment of physical function and capability (baseline, at admission, and daily) and cognition (at a minimum ________)
2. Establishing functional _____ based on assessments and communication with other members of the team and input from patients

Answer 35

1. Assessment of physical function and capability (baseline, at admission, and daily) and cognition (at a minimum daily)
2. Establishing functional goals based on assessments and communication with other members of the team and input from patients

Question 36

Atypical Presentation Consequences (of not identifying)
* Increased morbidity and mortality
* Missed diagnosis
* Unnecessary use of _______________

Answer 36

• Increased morbidity and mortality
• Missed diagnosis
• Unnecessary use of Emergency Rooms

Question 37

Atypical Presentation

It is essential to take _________ seriously from patients, family and non-professional care providers as to subtle symptoms such as mild confusion, changes in ability to perform activities of daily living (ADL), and decreased appetite

Answer 37

reports

Question 38

Illness: Atypical Presentation
Infectious diseases
* Absence of fever
* Sepsis without usual ____________ & ____________

Answer 38

leukocytosis and fever

Question 39

Illness: Atypical Presentation
“Silent” acute abdomen

• Mild discomfort and constipation
• Some tachypnea and possibly vague ___________ symptoms

Answer 39

respiratory

Question 40

Illness: Atypical Presentation
“Silent” malignancy
* _____ pain secondary to metastases from slow growing breast masses

Answer 40

Back

Question 41

Illness: Atypical Presentation
Silent” myocardial infarction
* ________ of chest pain
* Vague symptoms of fatigue, nausea and a decrease in functional status.

Answer 41

Absence

Question 42

Illness: Atypical Presentation

Depression
* Lack of _________
* Somatic complaints- appetite changes, vague GI symptoms, constipation, sleep disturbances
* Sadness misinterpreted by provider as normal consequence of aging

Answer 42

sadness

Question 43

“Hidden” Illness in Older Adults

Depression
Incontinence
Musculoskeletal stiffness
Falling
Alcoholism
Osteoporosis
Hearing loss
Dementia
Dental Problems
Poor nutrition
Sexual dysfunction
Osteoarthritis

Answer 43

Depression
Incontinence
Musculoskeletal stiffness
Falling
Alcoholism
Osteoporosis
Hearing loss
Dementia
Dental Problems
Poor nutrition
Sexual dysfunction
Osteoarthritis

Question 44

Factors that contribute to the under-reporting of illnesses are:

• A tendency on the part of patients and families to regard many of these symptoms as a
  “________” part of aging
• Reluctance of older people to complain about problems because of concerns as to being
  ignored or generating __________ tests

Answer 44

• A tendency on the part of patients and families to regard many of these symptoms as a
  “normal” part of aging
• Reluctance of older people to complain about problems because of concerns as to being
  ignored or generating burdensome tests

Question 45

Atypical Presentation of Common Geriatric Emergencies
* Acute abdomen with constipation and decreased appetite, rather than severe pain
* Pneumonia with vague chest pain and dry cough, rather than fever
* Depression with agitation, rather than dysphoria
* Infection with falls, rather than fever or elevated white count
* Sepsis with functional decline and generalized weakness, rather than fever
* Myocardial infarction with dyspnea and confusion, rather than chest pain
* Heart failure with fatigue, rather than dyspnea

Answer 45

• Acute abdomen with constipation and decreased appetite, rather than severe pain
• Pneumonia with vague chest pain and dry cough, rather than fever
• Depression with agitation, rather than dysphoria
• Infection with falls, rather than fever or elevated white count
• Sepsis with functional decline and generalized weakness, rather than fever
• Myocardial infarction with dyspnea and confusion, rather than chest pain
• Heart failure with fatigue, rather than dyspnea

Question 46

A geriatric __________ is a multifactorial condition that involves the interaction between
identifiable situation-specific stressors and underlying age-related risk factors, result-
ing in damage across multiple organ systems

Answer 46

syndrome

Question 47

Clinicians should attempt to treat or manage a geriatric syndrome even though a,_______________ may not be able to be identified. Whereas in a younger person a workup may look primarily for single diseases, the interaction of multiple physiologic changes and comorbidities in an older adult warrant a broader perspective. Diagnostic testing that would be relevant in a younger person may not be as beneficial in an older person, and/or may lead to unnecessary treatment and/or harm for the patient.

Answer 47

single cause

Question 48

A complete assessment of geriatric syndromes often requires an ______________
team approach, which may not be readily available in the typical outpatient practice

Answer 48

interprofessional

Question 49

Get Up and Go - Patient is asked to get up from an armchair without using his or her
hands. Then patient walks across the room (3 m) and turns and walks back to the chair and sits down. If this test takes >13.5 s to complete then he or she is at risk for future _______

Answer 49

falls

Question 50

Mini-cog - Clock-drawing test and 3-item recall. If both are normal, then rule out _________ impairment. If either one is abnormal, then screen in as cognitive impairment.

Answer 50

cognitive

Question 51

Urinary incontinence UI is frequently underreported because of the patient’s ___________ to discuss this with the physician and some misconception that it is part of normal aging.

Answer 51

embarrassment

Question 52

The 3 __________ Questions

1. During the past 3 mo, have you leaked urine? If the answer is yes, then complete the rest of the questionnaire.
2. During the past 3 mo, did you leak urine: when you were performing some physical activity? Without physical activity? When you had the urge to urinate, could you get to the toilet fast
   enough?
3. During the past 3 mo, did you leak urine most often: when you were performing some physical activity? Without physical activity? When you had the urge to urinate, could you get to the toilet fast enough?

Answer 52

Incontinence

Question 53

The most important geriatric syndromes to recognize in primary care are falls, urinary
incontinence, frailty, and cognitive impairment

Answer 53

The most important geriatric syndromes to recognize in primary care are falls, urinary
incontinence, frailty, and cognitive impairment

Question 54

· The three components of healthy aging are:

Answer 54

Functional ability
intrinsic capacity
environments.

Question 55

What are the four areas for action identified in the WHO document “Decade of Healthy Aging: Baseline Report.”

(Be able to list/write from memory #1, #2, #3, #4)

Answer 55

1. change how we think, feel and act towards age and ageing;
2. ensure that communities foster the abilities of older people;
3. deliver person-centred integrated care and primary health services that are responsive to older people;
4. provide access to long-term care for older people who need it.

Question 56

The World Health Organization defines healthy aging as (be able to write from memory, paraphrase as needed):

Answer 56

“the process of developing and maintaining the functional ability that enables well-being in older age”

Question 57

The following are risk factors for atypical presentation of disease in older adults:

Multiple___________ , multiple ___________, _____________ or functional impairment.

Answer 57

Multiple co-morbidities, multiple medications, cognitive or functional impairment.

Question 58

The well-intentioned imposition of bed rest upon an older adult (for their safety) is a care decision process that can lead to _______________

Answer 58

patient death.

Question 59

___________ ___________ status serves as a useful benchmark when developing function-focused discharge goals.

Answer 59

Baseline functional

Question 60

_______________ : Are multifactorial conditions that involve the interaction between identifiable situation-specific stressors and underlying age-related risk factors, resulting in damage across multiple organ systems.

Answer 60

Geriatric syndromes

Question 61

_______________ rounds can: Be an appropriate approach to promote function in an acute care setting by addressing baseline and current functional status, evaluating potentially restrictive devices and agents, prescribing appropriate medications, evaluating the discharge living situation, and creating a plan for progressive mobility.

Answer 61

Interprofessional

Question 62

· Emotional support, assistance, and relationships provided by people and animals are essential components of an older adult’s ____________ 11.

Answer 62

environment

Question 63

A significant indicator of overall health or illness in an older adult is their ability to ______ themselves, _________ themselves, and bath or perform personal hygiene.

Answer 63

A significant indicator of overall health or illness in an older adult is their ability to feed themselves, toilet themselves, and bath or perform personal hygiene.

Question 64

The following are examples of an IADL: _____ preparation, grocery shopping, taking daily __________ , and managing _________ / accounting.

Answer 64

The following are examples of an IADL: Meal preparation, grocery shopping, taking daily medication, and managing finances / accounting.

Question 65

A person’s ability to learn, grow, and make decision is related to their: _________________

Answer 65

Functional ability.

Question 66

For an older adult who lives alone and has good health, a sudden decrease in his ability to perform a ADLs. would prompt the prudent home health nurse to perform a thorough assessment of the ______ for _______________________ during their visit.

Answer 66

For an older adult who lives alone and has good health, a sudden decrease in his ability to perform a ADLs. would prompt the prudent home health nurse to perform a thorough assessment of the lungs for adventitious breath sounds during their visit.

Question 67

In older adults with severe musculoskeletal pain, a ___________ may be an appropriate strategy to maintain function, an important indicator of overall health.

Answer 67

mild opioid

Question 68

_______________________ q and identifying who is accountable for assessment and follow through are hospital/organizational level care processes that are essential for promoting and maintaining function in hospitalized older adults.

Answer 68

Well defined roles

Question 69

Be able to write from memory atypical presentation of disease symptom for an older adult with pneumonia.

Answer 69

Pneumonia with vague chest pain and dry cough,

[rather than fever]

Question 70

A hospitalized older adult with good baseline function is likely to lose __________ during an acute care hospitalization.

(Be careful on T/F questions look out for “is” and “is not” phrasing).

Answer 70

function

Question 71

A person’s sensory capacity (such as vision and hearing) are important components of their _________________

Answer 71

intrinsic capacity.

Question 72

The most important geriatric syndromes to recognize in primary care are

_______ , urinary ______________ , frailty, and _____________ impairment.

Answer 72

falls, urinary incontinence, frailty, and cognitive impairment.

Question 73

WHO DEFINES HEALTHY AGEING AS “the process of developing and maintaining the functional ability that _________________ in older age”

Answer 73

enables well-being

Question 74

• ADL – basic ____________ (bathing, dressing, grooming, eating, continence, transferring
• IADL – _____________ needed to take care of self or home (meal prep, medication administration, housework, transportation, accounting

Answer 74

• ADL – basic self-care (bathing, dressing, grooming, eating, continence, transferring
• IADL – daily things needed to take care of self or home (meal prep, medication administration, housework, transportation, accounting

Question 75

Baseline function – serves as a useful benchmark when developing __________ goals

Answer 75

discharge

Question 76

___________ decline – results from medications, acute illness, etc, typically reversible

Answer 76

Functional

Question 77

Atypical Presentation of Disease Risk Factors:

Answer 77

Over age 85
Multiple co-morbidities
Multiple medications
Cognitive or functional impairment

Question 78

Atypical Presentation of Common Geriatric Emergencies

• Heart failure with ___________ , rather than dyspnea

Answer 78

fatigue

Question 79

Atypical Presentation of Common Geriatric Emergencies

Acute abdomen with ____________ and decreased appetite, rather than severe pain

Answer 79

constipation

Question 80

Atypical Presentation of Common Geriatric Emergencies

• Depression with __________ , rather than dysphoria

Answer 80

agitation

Question 81

Atypical Presentation of Common Geriatric Emergencies

• Infection with ______ , rather than fever or elevated white count

Answer 81

falls