Week 3 Flashcards
Unlike their White counterparts,_____________ older adults experience significant health disparities, including lower life expectancies and an increased risk of chronic health conditions such as hypertension, diabetes, dementia, stroke, and cancer
African American
Research indicates thatbAfrican Americans—young and old—experience subtle and overt forms of ___________________
racial discrimination.
African American older adults have experienced cumulative race-related stressors that negatively impact their _______________________
physical and mental health
service providers in the aging and health-care fields need greater awareness, education, and training to competently address race-related stress in _____________ older adults
African American
For African American older adults, encounters are accumulated over the lifespan, stored in memory, and __________ with each new racist and discriminatory experience
relived
Limited access to community resources (e.g., grocery stores, pharmacies, culturally competent health and aging service providers, transportation, housing, etc.) significantly contributes to the experience of _______________ stress and creates barriers to achieving healthy and productive aging.
race-related
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Create ______ spaces. Provide opportunities for dialogue around race, culture, gender, sexuality, and socioeconomic issues.
Create safe spaces. Provide opportunities for dialogue around race, culture, gender, sexuality, and socioeconomic issues.
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Support, strengthen, and enhance ___________ .
resilience
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Be mindful of __________ . Pay attention to the impact of stressful events and incidents continuously showcased in the media (e.g., television, radio, or newspaper). When possible, limit exposure.
triggers
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Understand the impact of _________ . For African Americans, the effects of racism are felt daily. Racism also intersects with other forms of discrimination, including ageism, classism, sexism, ableism, and heterosexism.
racism
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
› Refer to ____________ services and support. Most African American older adults have developed effective coping skills (e.g., spirituality, kinship networks) to manage experiences of racism. However, when needed, culturally competent mental and behavioral health services should be made available.
mental health
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Celebrate _________ . Organize and encourage activities that celebrate African American life, history, culture, customs, and norms
culture
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
Listen with __________. Recognize and acknowledge past and present experiences. Provide support for the thoughts, feelings, and experiences shared
empathy
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
› Be _______. Consider your own cultural background and its influence on your values, beliefs, assumptions, and biases. Seek out training opportunities on culturally competent geriatric care, with special attention to race- related stress.
aware
CORE PRINCIPLES OF PAIN TREATMENT
Base the treatment plan on the older adult’s _______. Encourage older adults to set functional goals (e.g., performing certain daily activities, including socializing and hobbies). Older adults should determine treatment goals for themselves with input from health providers.
goals
WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO
› ___________. Support and promote local and national efforts to increase access to community and national resources for African Americans across the lifespan
Advocate
CORE PRINCIPLES OF PAIN TREATMENT
Every older adult deserves ____________ pain management. Certain populations, including racial minorities, people with limited ability to communicate, older adults, and people with past or current substance abuse, are at higher risk for inadequate pain management.
adequate
CORE PRINCIPLES OF PAIN TREATMENT
Use both drug and ___________ therapies. To achieve overall effectiveness of treatment, allow for reduction of drug dosages, and minimize adverse drug effects, always incorporate non-drug therapies into the pain management plan.
non-drug
CORE PRINCIPLES OF PAIN TREATMENT
Prevent and/or manage medication ___________ . Bothersome side effects are a major reason for treatment failure and non-adherence, and should be prevented when possible or managed aggressively
side effects
CORE PRINCIPLES OF PAIN TREATMENT
Evaluate the _____________ of all therapies to ensure that they are meeting the resident’s goals. Achievement of an effective treatment plan requires therapy to be individualized for each older adult, often requiring adjustments in drug, dosage, or route. Consistent reassessment is critical to good outcomes
effectiveness
CORE PRINCIPLES OF PAIN TREATMENT
Address pain using an inter-__________ approach. The multi-dimensional nature of the pain experience often requires the involvement of many disciplines. These can include psychology, physical and occupational therapy, pharmacy services, spiritual care, and multiple medical specialties, as well as complementary therapy practitioners, such as massage therapists, acupuncturists, and art therapists
disciplinary
A critical issue in aging research is whether aging is affected by ___________________ of underlying processes. If there are hundreds of different biological pathways that affect aging, then odds are slim that science could ever hope to devise a way of even understand why aging happens at all
one, several, or a multitude
Theories of aging can be divided into two categories:
those that answer the question “____ do we age?”
and those that address the question “_____ do we age?”
those that answer the question “Why do we age?”
and those that address the question “How do we age?”
The cross-linking hypothesis
Although many scientists agree that cross-linking of proteins, and perhaps the cross-linking of _______________ as well, is a component of aging, it is likely only one of several mechanisms that contributes to aging.
DNA molecules
THE EVOLUTIONARY SENESCENCE THEORY OF AGING
Natural selection, because it operates via reproduction, can have little effect on later life. In the wild, predation and accidents guarantee that there are always more younger individuals reproducing than older ones. Genes and mutations that have harmful effects but appear only after reproduction is over do not affect reproductive success and therefore can be passed on to future generations.
Natural selection, because it operates via reproduction, can have little effect on later life. In the wild, predation and accidents guarantee that there are always more younger individuals reproducing than older ones. Genes and mutations that have harmful effects but appear only after reproduction is over do not affect reproductive success and therefore can be passed on to future generations.
THE EVOLUTIONARY SENESCENCE THEORY OF AGING cont.
Because the gene’s harmful effects do not appear until after reproduction is over, they cannot be eliminated through_______________
natural selection.
THE GENOME MAINTENANCE HYPOTHESIS OF AGING
Mitochondria create damaging _________________ as a by-product of normal energy production. Somatic mutations in the DNA of the mitochondria accumulate with age, increasing free radical production, and are associated with an age-related decline in the functioning of mitochondria. Many scientists believe that mitochondrial aging is an important contributor to aging in general.
free radicals
THE GENOME MAINTENANCE HYPOTHESIS OF AGING
In fact, many scientists believe that humans have long lifespans because we are much better at _____________________ than short-lived animals like mice.
repairing our
genome
THE REPLICATIVE SENESCENCE HYPOTHESIS OF AGING
Most scientists today believe that what determines the Hayflick Limit for dividing human cells is the length of a cell’s ____________. Telomeres can be pictured as protective caps on the ends of chromosomes. Each time a
cell divides, it must first double its chromosomes, so that each daughter cell receives a full complement of genetic material. But each time a chromosome reproduces itself, it loses a small bit of its telomeres. Oxidative
damage can also shorten telomeres. When a cell’s telomeres have reached a critically short length, after 40 to 60 population doublings in young human cells, Certain skin cells produce collagen during their younger, reproductive years. When they reach senescence and can no longer divide, they produce collagenase, an enzyme that breaks down collagen. Some researchers suggest that this process may be responsible for the thinning and wrinkling of skin as we age. the cell can no longer replicate its chromosomes and thus will stop
____________. These cells with shortened telomeres become “senescent” in the sense that although they do not die, they can no longer divide
Most scientists today believe that what determines the Hayflick Limit for dividing human cells is the length of a cell’s telomeres. Telomeres can be pictured as protective caps on the ends of chromosomes. Each time a
cell divides, it must first double its chromosomes, so that each daughter cell receives a full complement of genetic material. But each time a chromosome reproduces itself, it loses a small bit of its telomeres. Oxidative
damage can also shorten telomeres. When a cell’s telomeres have reached a critically short length, after 40 to 60 population doublings in young human cells, Certain skin cells produce collagen during their younger, reproductive years. When they reach senescence and can no longer divide, they produce collagenase, an enzyme that breaks down collagen. Some researchers suggest that this process may be responsible for the thinning and wrinkling of skin as we age. the cell can no longer replicate its chromosomes and thus will stop
dividing. These cells with shortened telomeres become “senescent” in the sense that although they do not die, they can no longer divide
Polypharmacy is a common clinical issue in older adults; approximately 30% of senior citizens take at least ____ or more medications.
5
The normal changes of aging and physical changes associated with disease predispose older adults to an increased ______________ to prescription and over-the-counter medications.
sensitivity
Nurses should refer to the _______ Criteria and screening tool of older people’s prescriptions (STOPP) criteria when questioning the appropriateness of an elderly patient’s medications.
Beers
In lieu of pharmacologic measures, nurses should use patient-centered, evidence-based ______________ strategies to treat common symptoms.
nonpharmacologic
Polypharmacy in older adults is a _________ problem that has recently worsened. Approximately 30% of adults age 65 and older in developed countries take 5 or more medications.
Although older adults make up approximately 14.5% of the US population, elderly individuals purchase 33% of all prescrption drugs, and this proportion is expected to increase to 50% by the year 2040.
global
It not only includes prescribed medications but also over-the-counter and herbal preparations. Polypharmacy is most commonly defined in the health care literature as taking 5 or more medications. ________________ has been described as taking 10 or more medications
Hyperpolypharmacy
Polypharmacy is associated with the development and worsening of _________________, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. 7 Polypharmacy in older adults also increases the risk of adverse drug events (ADEs) and avoidable hospitalizations. Polypharmacy also has financial conse- quences, as it results in increased health care costs for the patient and for the health care system. Treatment for medication errors and ADEs in the older adult population is estimated to cost more than 880 million dollars per year. 8 In 2012, inappropriate polypharmacy cost 1.3 billion dollars in avoidable health care costs
geriatric syndromes,
A prescribing ___________ begins when a side effect or adverse drug reaction of a medication is misinterpreted as a new health condition, thus resulting in the prescription of a new medication
cascade
Medications should be started at _____ doses, and the nurse should monitor patients for adverse reactions
low
Half of all people age 65 and older have at least ____ medical diagnoses, and one-fifth have 5 or more medical conditions. 16 It is not uncommon for older adults with multiple medical problems to be treated by different medical specialist
3
older adults are more sensitive to many medications and are also more sensitive to medication ___________ . The bedside nurse should anticipate that older adult patients have the potential to respond differently to medications than other age groups
changes
Metabolism
The most common site of drug metabolism is the liver. Given the normal aging changes of decreased hepatic blood flow and decreased hepatic size and mass, the older adult’s hepatic metabolism of medications is _________ . This reduction may lead to elevated concentrations of medications in the body and, thus, ADEs. For
example, in older adults, there is an approximately 60% reduction in the metabolism of NSAIDS and anticoagulant agents. 19 Given the potential for an increased concentration and duration of these medications, an elderly patient taking this medication combination has an elevated risk of gastrointestinal bleeding.
reduced
Elimination
Most medications are eliminated through the kidneys. Kidney function starts to decline in the fourth decade of life. Many older adults have some degree of renal compromise; thus, medications may take __________ to be cleared from the body, and there is a higher risk of toxicity. A patient’s estimated glomerular filtration rate should be taken into account when prescribing medications that are renally eliminated. Renally eliminated
medication dosages and frequencies should be adjusted in the presence of kidney disease
longer
The aging body’s loss of cell function influences pharmacodynamics of medications, typically causing older adults to be more __________ to medications.
sensitive
Consequences of Polypharmacy
Adverse drug event An ADE is an _________ that results from use of a medication
injury
Risk factors of adverse drug events in the elderly
Age >85 y
Frailty
Low body weight or body mass index
Six or more chronic health conditions
Memory problems
Estimated CrCl <50 mL/min
9 1 medications (prescribed and over the
counter)
12 1 doses of medications/d
Prior ADE
Multiple prescribers
Multiple pharmacies
No regular reviews of patient’s medication list
Poor communication among providers
Prescription of complex medical regimens
Age >85 y
Frailty
Low body weight or body mass index
Six or more chronic health conditions
Memory problems
Estimated CrCl <50 mL/min
9 1 medications (prescribed and over the
counter)
12 1 doses of medications/d
Prior ADE
Multiple prescribers
Multiple pharmacies
No regular reviews of patient’s medication list
Poor communication among providers
Prescription of complex medical regimens
Approximately __.3 million health care visits were attributed to ADEs in 2005. Up to 35% of community-dwelling older adults have experienced an ADE that was discovered during an outpatient visit, and 40% of hospitalized older adults have experienced an ADE as well.
4
Costs
______ can cause unnecessary emergency department visits and hospitalizations. which contributes to increased health care costs for the patient and the health care system.
ADEs
________ Criteria - a rigorous clinical practice guideline published by a panel of experts who have conducted a comprehensive evidence review to identify medications that may confer additional risk to older adults.
Beers
_____________- a patient-centered deprescribing framework has been proposed as a novel method for considering an older adult’s comprehensive health and medication list with specific attention to reducing PIMs.
Deprescribing
Using evidence-based strategies to reduce PIMs should be considered during care transitions (eg, from hospital to home, from home to nursing facility), as care transitions are known to be a common juncture for medication errors. Hospitalization may be another appropriate time to reduce ______ and to consider whether any of the patients’ medications could have contributed to their hospital admission
PIMs
Conversations about medications should begin by listening to patients’ ___________, preferences, and goals of care
concerns
Registered nurses have many opportunities to facilitate __________ to reduce polypharmacy in older adults.
deprescribing
nurses may have the opportunity to identify ADEs. By elevating concerns about potential ADEs, nurses may prompt conversations about ______________ . Bringing knowledge of polypharmacy, its associated adverse
outcomes, and specific frameworks for deprescribing (eg, Beers criteria, STOPP/ START criteria) may enhance the effectiveness of communication with prescribers.
deprescribing
_________ have the opportunity to lead initiatives aiming to educate interdisciplinary team members and patients on improved medication management practices.
nurses
Nurses can encourage the use of in-home systems to promote accurate medication ________, and they can also facilitate in-person methods of reconciling and educating patients about their medications
taking
brown bag review begins by asking a patient to bring ______________________, including over-the-counter and herbal agents, to their health care visit.
all of their current medications
_____________ is a growing problem in the United States and demands the attention of the registered nurse. Nurses in all health care settings have opportunities to reduce and prevent polypharmacy through implementation of evidence-based practices and delivery of person-centered care.
Polypharmacy
there are more than __.7 million LGBT adults ages 50 or older living in communities across the country.
2
it is estimated that there are approximately 2.7 million LGBT adults aged 50 and older in the United States, ___ million of whom are 65 and older.Broadly, these LGBT adults comprise the community referred to as “LGBT elders” in this report.
1.1
Key challenges for LGBT older adults
Discrimination
lack of legal/social _________
reliance on chosen family
lack of competent inclusive __________
Discrimination
lack of legal/social recognition
reliance on chosen family
lack of competent inclusive healthcare
APPROXIMATELY ONE IN FIVE (20%) LGBT OLDER ADULTS ARE PEOPLE OF __________
COLOR
________ OF LGBT OLDER ADULTS LIVE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL
ONE-THIRD
Major areas of life in which LGBT elders face particular disparities:
A lifetime of discrimination, especially in housing and ___________ , and a long-term lack of legal and social recognition combine to create deep economic insecurity for LGBT elders.
employment
Major areas of life in which LGBT elders face particular disparities:
A reliance on chosen family, due to family __________ and legalized discrimination, creates social isolation and vulnerability for LGBT elders.
rejection
Major areas of life in which LGBT elders face particular disparities:
Long-term discrimination, combined with a lack of competent, inclusive health care, leads to specific mental and physical health ____________.
disparities
LGBT older adults experience ___________ stress [impact of interpersonal and structural discrimination]. Minority stress has negative impacts on health and well-bein.
minority
6-23% of LGBT older adults have experienced:
Verbal/Physical Harassment From Other Residents 23%
Refused Admission, Attempted/Abrupt Discharge 20%
Verbal/Physical Harassment From Staff 14%
Staff Refused to Accept Medical Power of Attorney from Resident’s Spouse/Partner 11%
Restriction of Visitors 11%
Staff Refused to Refer to Transgender Resident by Preferred Name/Pronoun 9%
Staff Refused to Provide Basic Care 6%
Staff Denied Medical Treatment 6%
Verbal/Physical Harassment From Other Residents 23%
Refused Admission, Attempted/Abrupt Discharge 20%
Verbal/Physical Harassment From Staff 14%
Staff Refused to Accept Medical Power of Attorney from Resident’s Spouse/Partner 11%
Restriction of Visitors 11%
Staff Refused to Refer to Transgender Resident by Preferred Name/Pronoun 9%
Staff Refused to Provide Basic Care 6%
Staff Denied Medical Treatment 6%
POLYPHARMACY AND OLDER ADULTS
- APPROX ___% OF ADULTS 65+ ARE ON 5 OR MORE DRUGS
30
POLYPHARMACY AND OLDER ADULTS
- NORMAL AGING CAN INCREASE ____________ OF DRUGS
SENSITIVITY
POLYPHARMACY AND OLDER ADULTS
- OLDER ADULTS PURCHASE ____% OF ALL PRESCRIPTION DRUGS
30
POLYPHARMACY AND OLDER ADULTS
-ASK ABOUT ____________!!!!
SUPPLEMENTS
- POLYPHARMACY: __+ MEDS
- HYPERPOLYPHARMACY: __+ MEDS
- POLYPHARMACY: 5+ MEDS
- HYPERPOLYPHARMACY: 10+ MEDS
ELIMINATION: KIDNEYS
- NORMAL _____________ COULD EFFECT HOW DRUGS ARE ELIMINATED.
- TEST BUN/CREATININE AND GFR
ELIMINATION: KIDNEYS
- NORMAL KIDNEY DECLINE COULD EFFECT HOW DRUGS ARE ELIMINATED.
- TEST BUN/CREATININE AND GFR
METABOLISM: LIVER
THERE IS A DECREASE IN _________________ WITH AGE
HEPATIC BLOOD FLOW
________________ EVENT RISK FACTORS:
- > 85 y/o
- Frailty
- Low weight/Low BMI
- > 6 conditions
- Creatinine <50
- Prior ADE
- 9+ meds
ADE: ADVERSE DRUG
- Brown Bag: bring ___________ to your PCP
all meds
3 KEY CHALLENGES FACING LGBTQIA+ INDIVIDUALS:
- A LIFETIME OF _____________ + LACK OF LEGAL/SOCIAL RECOGNITION
- RELIANCE ON _________ FAMILY
- A LACK OF COMPETENT, INCLUSIVE ____________
- A LIFETIME OF DISCRIMINATION + LACK OF LEGAL/SOCIAL RECOGNITION
- RELIANCE ON CHOSEN FAMILY
- A LACK OF COMPETENT, INCLUSIVE HEALTHCARE
THEORIES OF AGING: CROSS LINKING/GLYCATION HYPOTHESIS
DNA DEVELOPS ___________________________ TO ONE ANOTHER BONDS DECREASE MOBILITY + ELASTICITY OF MOLECULES
INAPPROPRIATE CROSS LINKS
THEORIES OF AGING: EVOLUTIONARY SENESCENCE
- THE FAILURE OF NATURAL SELECTION TO AFFECT ____________
- MUTATIONS THAT OCCUR IN THE AGING INDIVIDUAL WILL NOT BE PASSED ONTO
OFFSPRING
LATE LIFE TRAITS
THEORIES OF AGING: GENOME MAINTENANCE HYPOTHESIS
FREE RADICALS CAUSE ____________
MITOCHONDRIAL AGING
MUTATIONS
THEORIES OF AGING: REPLICATION SENESCENCE:
- ____________ NO LONGER DIVIDE OR DON’T DIVIDE AS WELL
TELOMERES
Understand older adults may display and communicate ______ differently than other groups of people
pain
Racial minorities, people with limited ability to communicate, older adults, and people with past or current substance abuse, are at higher risk for inadequate _______________
pain management.
· About ______ of older adults in the developed world take 5 or more medications (polypharmacy).
3/10
· Older adults are often initially prescribed medications at or ______ ________ drug doses, due to their physiologic and sensory changes.
below “Normal”
· eGFR (estimated glomerular filtration rate) can be used to evaluate the kidney function of a patient taking __________.
vancomycin
· An ADE (adverse drug event) is an injury that results from __________________
use of a medication.
__________ ___________ _____________ are evidence-based pharmacology tools available to guide healthcare providers in making pharmacologic decisions for older adults (Be able to fill-in the blank from memory).
BEERS, START, and STOPP
___________ __________ is a focus of the replicative senescence hypothesis of aging.
Telomere length
Cumulative race-related stress can negatively impact a patient’s mental health, such as being withdrawn and less interactive. If you are caring for a patient that is displaying these behaviors (withdrawn and less interactive) you’ll want to discuss with the provider, the need for ___________________________________________________ consultation and treatment. (This covers at least two questions).
culturally competent mental health service
At least 3 challenges faced by LGBT older adults:
A lifetime of discrimination and lack of legal and social _____________,
A ____________ on chosen family,
A lack of competent inclusive ____________.
A lifetime of discrimination and lack of legal and social recognition,
A reliance on chosen family,
A lack of competent inclusive healthcare.
Training opportunities on culturally competent geriatric care would be beneficial for a new nurse who has started working with a ______________________ care clients.
diverse group of long-term
________ percent of older LGBT older adults are from a racial/ethnic minority group.
Twenty
Being LGBT and from a racial/ethnic minority ________ your risk for disparities across many measures of wellbeing, including physical and mental health outcomes, economic security, and experiences of discrimination.
increases
Essay: Describe one specific take-away from Michelle’s story in Baltimore.
African american adults are 50% more likely to die prematurely from a heart disease or stroke
Essay: Provide an example of “breaking the script” in conversations with older adults, using the PBS Newshour “A brief but spectacular take on breaking the script” as the reference.
Do not assume their heterozexuality; instead of asking “are you married” ask who is your biggest support?
When considering pain management in older adults, ___________________ goals are one of the most important aspects.
individual pain management
________________ of health (SDH) are a common underlying cause of racial and ethnic minority older adults having increased chronic disease burden compared to the majority White population.
Social determinants
Be able to List three risk factors for an adverse drug event in an older adult.
Age >85 y
Frailty
Low body weight or body mass index
Six or more chronic health conditions
Memory problems
Estimated CrCl <50 mL/min
9 1 medications (prescribed and over the
counter)
12 1 doses of medications/d
Prior ADE
Multiple prescribers
Multiple pharmacies
No regular reviews of patient’s medication list
Poor communication among providers
Prescription of complex medical regimens
Be able to describe the prescribing cascade (essay).
when a side effect or adverse drug reaction of a medication is misinterpreted as a new health condition, thus resulting in the prescription of a new medication
· Checking your patient’s liver function tests may be warranted because decreased hepatic blood flow and decreased hepatic size and mass, might result in the older adult’s ___________________________________________________
hepatic metabolism of medications being reduced.
