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Geriatrics Eval > Week 4 > Flashcards

Week 4 Flashcards

1
Q

name the 4 types of dementia.

A
  • alzheimer’s
  • vascular dementia
  • lewy body dementia (LBD)
  • frontotemporal dementia
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2
Q
  • cognitive screening tool
  • examines orientation (time and place), immediate and delayed recall, attention and calculation, language and visuospatial ability
  • useful for quantitively estimating the severity of cognitive impairment and documenting cognitive changes
  • sensitive and specific
A

mini-mental status exam

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3
Q
  • quick screening tool for probable dementia (2-4 minutes)
  • combines word recall with clock draw
  • sensitivity and specificity are strong
  • performance on test is not influenced by education level or language skills
A

mini-cog

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4
Q
  • a rapid screening for mild cognitive impairment
  • assesses attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation
A

montreal cognitive assessment (MOCA)

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5
Q
  • a functional measure that examines level of cognitive support required by a person with dementia to complete a cooking task.
  • client asked to prepare a box of pudding with set up, instructions for stove use, directions for locating items, large print instructions available.
  • cueing provided as needed (verbal and physical)
  • initiation, organization, performance of all steps, sequencing, judgment, safety and task completion noted
A

kitchen task assessment (KTA)

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6
Q

what does the KTA provide information about?

A

provides info regarding assistance level needed

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7
Q
  • provides information that reveals a client’s ability to deal with safety hazards
  • clients are asked to identify and correct 8 safety hazards in the kitchen
  • avoid cueing the client, note number of times instructions have to be repeated.
  • use ambulation device as needed
  • do not enter kitchen unless client can state instructions
  • note order hazards are found and safely corrected, how the environment is scanned, balance and coordination.
  • safety with corrections depends on mobility status.
  • non-standardized but useful for discharge planning
A

robnett home safety screening

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8
Q

name the 4 main intervention approaches for individuals with dementia/cognitive impairment.

A
  • task-specific training
  • COPE
  • theory-based activities for behavioral symptoms
  • TAP
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9
Q
  • used for individuals with mild to moderate dementia
  • determine client’s valued roles and associated tasks
  • constant practice using graded cues
  • incorporate external memory strategies
  • visual feedback and verbal praise
  • practice without error
  • verbal or physical assistance to perform task correctly
A

task-specific training

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10
Q

what does COPE stand for?

A

care of persons with dementia in their environment

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11
Q
  • designed for clients with middle to late stage dementia
  • clients exhibit functional dependence and behavioral symptoms
  • caregiver distress noted
A

COPE

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12
Q

name the 5 COPE principles.

A
  • client-centered and client-directed
  • customized and tailored
  • culturally relevant
  • problem-solving
  • active engagement - learn by doing
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13
Q
  • multi-component intervention
  • home-based intervention
  • requires training
A

COPE

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14
Q

what is the goal of COPE?

A

to reduce environmental stressors and improve caregiver skills

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15
Q

which types of visits does COPE consist of?

A

2 NP visits and 10 OT visits

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16
Q

describe phase 1 of COPE OT visits.

A

2 visits for assessment

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17
Q

describe phase 2 of COPE OT visits.

A

treatment, including provision of COPE prescriptions over 6 sessions

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18
Q

describe phase 3 of COPE OT visits.

A

promote generalization of strategies, 2 visits

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19
Q

describe 4 roles of the OT for the COPE intervention.

A
  1. interview caregiver to determine patient routines, previous and current roles, interests and habits.
  2. assess cognitive skills - attention, initiation, perseveration, memory
  3. provide caregiver training regarding home modification, adapting activities, communication strategies, use of problem-solving
  4. provide written action plan for each targeted concern
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20
Q

name 4 COPE strategies.

A
  • communicate effectively
  • modify the home
  • reduce the complexity of the task (simplify the activity)
  • enhance activity participation
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21
Q

name 3 outcomes of COPE intervention.

A
  • improves caregiver well-being
  • decreases functional dependence
  • improves engagement
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22
Q

which type of care setting are theory-based activities for behavioral symptoms most useful for?

A

long-term care setting

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23
Q

what are the MMSE scores that must be obtained to use theory-based activities for behavioral symptoms?

A

8-24

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24
Q
  • based on need-drive dementia-compromised behavior model

- participation in activities adjusted for personality and functional level

A

theory-based activities for behavioral symptoms

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25
Q

what is the name of the questionnaire used to determine personality type for theory-based activities for behavioral symptoms?

A

NEO-PI-R

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26
Q

depression, anxiety, self-consciousness

A

neuroticism

27
Q

gregariousness, assertiveness, activity, excitement seeking

A

extraversion

28
Q

fantasy, feelings, ideas, aesthetics, actions

A

openness to experience

29
Q

altruism, straightforwardness, tendermindedness

A

agreeableness

30
Q

order, achievement striving, dutifulness

A

conscientiousness

31
Q

name the 2 functional levels considered for theory-based activities for behavioral symptoms.

A
  • cognitive skills

- physical function

32
Q

name 4 activity examples for theory-based activities for behavioral symptoms.

A
  • bicycle with front seat
  • tether ball
  • removing items for tackle box or purse
  • feelings cube
33
Q

name 3 outcomes for the theory-based activity program.

A
  • improved engagement
  • decreased passivity
  • decreased agitation
34
Q
  • tailored towards interests and ability
  • culturally relevant
  • problem solving: collaborate with caregiver
  • active engagement (practice the activity)
  • client-centered (caregiver status)
A

tailored activity program (TAP)

35
Q

name the 3 components of a TAP assessment.

A
  • client: interests, roles, occupations, cognitive status, mobility, sensation
  • environment
  • caregiver
36
Q

describe the 4 components of TAP activity prescription.

A
  • 3 potential activities tailored to client capacities, environment, and caregiver
  • training and practice (set up, cueing, monitoring)
  • generalization: modifying the activities, practice communication, link strategies to everyday activity
  • activity schedules
37
Q

name 2 TAP outcomes.

A
  • reduced frequency of problem behaviors, greater activity engagement
  • caregivers had less time “on duty”, increased self-efficacy, and skill enhancement
38
Q

describe 4 strategies for communicating with clients with dementia (mild stage).

A
  • take time to listen to how the person is feeling
  • give time to respond
  • don’t interrupt or finish sentences
  • explore which method of communication is most comfortable
39
Q

describe 12 strategies for communicating with dementia (moderate stage).

A
  • identify yourself, use the client’s name
  • use short words and simple sentences
  • one question at a time
  • speak slowly
  • repeat as needed after a pause
  • give visual cues
  • avoid quizzing
  • ask yes/no questions
  • use friendly facial expressions and tone of voice
  • use positive phrases
  • go along with what is said
  • use distractions to redirect the client
40
Q

name 3 strategies for communicating with clients with dementia (severe stage).

A
  • approach the person from the front
  • encourage non-verbal communication
  • emotions expressed may be more important than what is being said
41
Q

difficulty with memory, trouble with orientation to time and space, difficulty with new learning

A

early stage alzheimer’s disease

42
Q

people become more repetitive - repeat themselves over and over again, have difficulty with familiar tasks, have difficulty recognizing people

A

middle stage alzheimer’s disease

43
Q

people respond more globally (respond to their name with eyes moving, for ex.), issues around incontinence, swallowing problems

A

late stage alzheimer’s disease

44
Q

which is the last type of memory to go?

A

procedural memory

45
Q
  • interruption to the blood supply to the brain

- could have a stepped progression where they are functioning at a certain level and then see a drop in function.

A

vascular dementia

46
Q

issues with motor skills, issues with cognitive deficits as we see in other types of dementia, hallucinations, muscle rigidity, balance problems

A

lewy body dementia

47
Q

number of different disorders that affect the frontal and temporal lobes - changes in personality, disinhibited, deficits in language skills - unable to communicate using language, muscle rigidity, impaired coordination

A

frontotemporal dementia

48
Q

what are MMSE scores for mild dementia?

A

21-26

49
Q

what are MMSE scores for moderate dementia?

A

11-20

50
Q

what are MMSE scores for severe dementia?

A

0-10

51
Q

mild cognitive impairment, not affecting your memory as much as other things - being able to find your way in space is a common issue

A

nonamnestic

52
Q

describe scoring for the MOCA.

A

score of 26 or above - person is consider normal, lower scores = cognitive impairment

53
Q

describe the pretest for the kitchen task assessment.

A

instruct pt. to go into the kitchen and wash their hands - if they can’t do that, you don’t continue with the assessment

54
Q

is the KTA a static or dynamic assessment?

A

dynamic

55
Q

describe scoring for the KTA.

A

0-18 - higher score indicating a higher level of impairment

56
Q

is cueing involved in the Robnett home safety screening?

A

no

57
Q

describe covert vs overt hazards.

A

overt are more obvious and covert are more hidden.

58
Q

task-specific training capitalizes on what type of memory?

A

procedural memory

59
Q

don’t let them make a mistake

A

practice without error

60
Q

COPE is tailored towards which types of people?

A

people who have functional dependence (require a lot of assistance)

61
Q

COPE engages the caregiver in what?

A

problem-solving and active engagement

62
Q

which type of personality would like to participate in the bicycle with front seat activity?

A

openness to experience

63
Q

which type of personality would like to engage in the tether ball activity?

A

extraversion

64
Q

describe the difference between TAP and COPE.

A

TAP is just activity prescriptions and schedules but COPE goes beyond that and involves nursing, strategies, activity modification, communication strategies, environmental modifications

Geriatrics Eval (12 decks)

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