Chapter 1 - The Aging Population
Which of following statements most accurately captures the role of chronic illness in the lives of older adults? A) Chronic illnesses constitute the leading cause of death for older adults. B) More older adults die from acute illnesses than from chronic diseases. C) While chronic diseases used to be the leading cause of death, this is no longer the case. D) While cancer rates have fallen, other chronic diseases remain a common cause of death.
Ans: A Feedback: Chronic illnesses constitute the leading cause of death for older adults, exceeding those attributed to acute illnesses. The presence of heart disease as a cause of death has decreased in recent years, while at the same time cancer has become more prevalent.
Twentieth-century laws regarding health care for the elderly trace their roots back to: A) England's 17th-century Poor Laws B) Child labor laws of the 19th century C) The Biblical commandment "Honor your father and your mother" D) The tradition of respect for the elderly passed down from ancient Roman law
Ans: A Feedback: Laws enacted in 20th-century America provided some measure of financial security and some level of health care for all persons aged 65 years and older, just as did the Poor Laws of 17th-century England that acted as a "safety net" for the elderly and the destitute. The child labor laws protected the young but offered no help to the elderly who were left at the mercy of their families. The Biblical commandment to "honor" provides a moral guideline but no practical benefit in terms of financial or health support. Ancient Romans deplored the elderly, and no tradition of respect for the aged was incorporated into the Roman legal code.
What are the most important competing forces that influence health policy for the elderly? A) Cost containment versus quality of care B) Acute care versus the burden of chronic disease C) Private insurance payments versus Medicare support D) Long-term care at home versus nursing home services
Ans: A Feedback: Policy discussions most often pit cost containment (reducing expenditures) against quality of care (which may mean increasing expenditures). Seniors require relatively less acute care than younger patients do; their health problems are more often chronic. Because all persons over age 65 are entitled to health coverage through Medicare, insurance considerations are fewer than with younger patients. And whereas one in four seniors requires nursing home care at some time, nursing home residency is not typically long term.
A nurse who practices in a long-term care facility is providing care for a 101-year-old black female. The nurse's coworker states, "It's gratifying that black people in this country are finally reaching the same levels of health that white people are enjoying." How can the nurse best respond? A) "Actually, the difference in life expectancy between black people and white people is growing, not shrinking." B) "We've not yet arrived at a place where the life expectancies are equal between black and white people, but the gap is decreasing gradually." C) "Black women do tend to live longer than white women, but the overall life expectancies when men are included are not yet equal." D) "You're right. Since the 1980s the life expectancies of black and white Americans have remained nearly the same."
Ans: A Feedback: Since the 1980s, the gap between life expectancies of black Americans and white Americans has been increasing rather than decreasing. Black women do not tend to live longer than white women.
Which of the following phenomena most likely accounts for the fact that more women than men live alone later in life? A) Women tend to both live longer than men and marry men older than themselves. B) Men tend to have greater access to care facilities due to higher incomes and savings. C) Men are more likely to live with younger family members following the death of a spouse. D) Social pressures tend to stigmatize older men who live alone.
Ans: A Feedback: The facts that women live longer than men and often marry men older than themselves account for their higher rates of living alone in old age. Men are not noted to have greater access to care facilities, to be more likely to live with younger family members or to face stigma for living alone.
A new patient is not satisfied with the conditions of the nursing home, takes a highly active role in her health care, and, because of her ability to access information, has as much knowledge as her health care providers on some health issues. This new patient is most likely: A) A young-old female baby boomer who just turned age 65 B) An old woman 75 to 85 years of age C) An old-old woman over age 85 D) An elite old woman older than 100 years
Ans: A Feedback: The patient has the predicted characteristics of a baby boomer entering the senior years.
The board of a large chain of hospitals has commissioned a strategic plan in order to meet the care needs of baby boomers in coming years. Which of the following trends constitute a sound basis for understanding the baby boomer generation and conducting future planning? Select all that apply. A) Baby boomers tend to have fewer children than members of earlier generations. B) Adjusted for inflation, baby boomers have lower incomes than their parents had. C) Due to technology, baby boomers have more leisure time than other adults. D) Baby boomers perform physical exercise more frequently than other adults.
Ans: A, D Feedback: Baby boomers have had fewer children than generations that preceded them and they tend to exercise more often. Their incomes tend to be higher while they enjoy less leisure time.
Which of the following patient histories is most likely for a person older than 65 years of age? A) In the last year, Patient F has been treated for a skin rash, a sprained ankle, and influenza B) Patient G takes medications daily for arthritis pain relief and reduction of blood pressure levels C) Patient H complains of chronic fatigue, stress-related allergies, and acid reflux after meals D) Patient I has been to the emergency room three times in the past year for ear infections and allergy attacks
Ans: B Feedback: Arthritis and heart conditions are among the most common chronic conditions of the elderly. Daily medications to reduce arthritis pain and decrease blood pressure are common. The other histories are more likely for younger patients.
Hospital management is reviewing departmental statistics. Which of the following departments most likely has the highest death rate of patients over age 65, and why? A) Oncology, because the elderly have been exposed to more carcinogens in their long lifetimes B) Cardiology, because, despite a decline in recent years, heart disease remains the number one cause of death among the elderly C) Endocrinology, because the elderly already have compromised immune systems D) Neurology, because stroke and Alzheimer's disease together cause more deaths of the elderly than any other conditions
Ans: B Feedback: Heart disease is the leading cause of death among persons 65 years of age and older.
Which of the following statements best captures an aspect of illness in older adults? A) Death from heart disease is increasing in this population. B) Death from cancer is increasing in this population. C) Chronic illnesses are less common than in younger people. D) Several acute illnesses are often present that must be managed simultaneously.
Ans: B Feedback: In the elderly population, the cancer death rate has increased in the past three decades; deaths from heart disease have declined. Several chronic conditions are often present and must be managed simultaneously.
Which of the following factors should a nurse prioritize when planning the care of older adults? A) The high prevalence of mental impairment among the elderly B) The diversity of the older adult population C) The fact that most older people live below the poverty line D) The lack of family support that is the norm among the elderly
Ans: B Feedback: Individuals aged 65 years and older vary widely in their health status, interest, cultural backgrounds, and health care needs. The population is not generally impaired mentally. Also, only 15% live below the poverty level. The majority live in a household with a spouse or other family member.
It is important for the nurses to be aware of their patients' financial situations, which can affect patients' nutritional needs and access to medical care. Which of the following applies to the majority of older people? A) Own their own homes and have sufficient monthly income B) Get more than half their income from Social Security and live above the poverty level C) Are an increasing percentage of the labor force but are "cash poor" D) Are retiring at earlier ages and so live below the poverty level
Ans: B Feedback: Less than 15% of older people live below the poverty level. Social Security is the main source of income for more than half of all older adults.
In ancient times, the relationship between age and the value afforded to individuals was generally: A) Positive: with advanced age came increased value B) Negative: respect declined as age increased C) Variable: respect was different in different cultures D) Cyclic: respect moved back and forth between positive and negative
Ans: C Feedback: Attitudes toward the aging varied among cultures. The ancient Chinese, for example, believed that the elderly deserved honor and respect, whereas the ancient Romans had little respect for the elderly, customarily killing them first in the nations Rome conquered.
A public health nurse who directs a homecare program that serves an area with a large population of older adults is conducting a long-term strategic plan. Which of the following phenomena should the nurse take into account when planning for the future? A) While life expectancy will continue to rise, the percentage of older adults in the United States relative to the overall population will decrease. B) By 2020, it is expected that over one-third of Americans will be over the age of 65. C) Both life expectancy and the percentage of people over 65 in the population will increase in coming decades. D) Chronic conditions, such as diabetes, are expected to bring a gradual decrease in the number of older adults by 2020.
Ans: C Feedback: Both life expectancy and the percentage of individuals over age 65 are expected to increase in coming years. About 17% of the population is expected to be over 65 by 2020.
When compared with elderly populations of the past, persons entering their senior years between 2015 and 2030 will have: A) Fewer chronic diseases but more acute illnesses B) Greater support from their children and spouses C) Better education and greater wealth D) Fewer needs for hospital or nursing home care
Ans: C Feedback: The baby boomer cohort attained higher levels of education and economic status than past generations. They have, however, fewer children and the same (or greater) burdens of chronic disease and needs for health care as their parents did.
From the late 1980s to the present, the gap in life expectancy between individuals in the Caucasian and African American communities has widened. Which of the following most clearly accounts for this trend? A) Acute illness in the black population has increased B) Infant mortality and complications of childbirth in the white population have declined C) The life expectancy of African Americans has not increased at the same rate as that of the white population D) Deaths from homicide in the white population have increased
Ans: C Feedback: The gap in life expectancy between white individuals and African Americans has widened because the life expectancy of African Americans has not increased at the same pace as that of Caucasians. The U.S. Department of Health and Human Services attributes this decline to an increase in deaths from homicide and AIDS.
A care aide employed on a geriatric medicine unit of a hospital expresses frustration that "old people get sick so much more often than young people." What is the nurse's most appropriate response to this statement? A) "In fact, the prevalence of obesity and accompanying chronic illnesses mean that young people actually have more chronic conditions than older adults." B) "It's actually a myth that older adults require more hospitalization than young people." C) "Actually, older adults experience fewer acute illnesses than younger people, it's just that they tend to take longer to recover from them." D) "With the increase in life expectancies in recent years, most older people actually live free of chronic diseases until very late in life."
Ans: C Feedback: The incidence of acute illness is lower among older adults than younger adults, though recovery times tend to be longer. Older adults tend to have a higher incidence of chronic illness and require more frequent and longer hospitalizations.
Which of the following statements by the daughter of an 87-year-old resident of a nursing home would the nurse most likely want to correct or clarify? A) "It seems like more and more people are living well into their 80s like my mom." B) "My mom has a house worth loads of money but little cash flow, like many older adults." C) "It seems like heart disease is getting more common even though people live longer than they used to." D) "There are more women living to my mother's age than there are men."
Ans: C Feedback: The incidence of heart disease as a cause of death is on the decline. More Americans are indeed achieving old age and many older adults have valuable assets but little cash flow. Female longevity continues to exceed that of males.
Which of the following statements most accurately captures the financial status of older adults in the United States? A) The percentage of older people living below the poverty level has been increasing. B) The financial needs of most older adults are well met by Social Security income alone. C) The recent decline in housing prices has made many older adults "asset rich and cash poor." D) Women 65 years of age and older is the fastest growing group of employment.
Ans: C Feedback: The percentage of older people living below the poverty level has been declining, with about 10% now falling into this category. Most older people depend on Social Security for more than half of their income. Although the median net worth of older households is nearly twice the national average because of the high prevalence of home ownership by elders, many older adults are "asset rich and cash poor." The recent decline in housing prices, however, has made that asset a less valuable one for many older adults. There has been a significant rise in the percentage of middle-aged women who are employed, although there has been little change in the labor force participation of women 65 years of age and older.
What is the most important factor contributing to limitations in self-care and independent living among the elderly? A) Lack of family support B) Low financial assets C) Acute illness and injury D) Chronic illness
Ans: D Feedback: Chronic illnesses are noted to have a significant impact on the quality of life of older adults. These illnesses are more prevalent than acute illnesses and supersede deficits in family and financial support.
Gerontological nursing will become an increasingly important profession, compared with in the past, because: A) More people will be presenting with the same health care challenges B) More elderly are living in increasingly squalid living conditions C) A greater number of people are surviving the previously hazardous period of infancy D) More people are spending a longer time span in old age
Ans: D Feedback: More people are achieving and spending longer periods of time in old age than ever before in history. Declines in living conditions, increased prevalence and incidence of the same health problems, and higher survival rates during infancy do not account for the increased importance of gerontological nursing.
The family of an 85-year-old man who has been admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) has expressed concern about their ability to pay for his present and future care. Which of the following statements most accurately conveys the reality of payment for care services by older adults? A) The high value of assets owned by older adults makes the financial burden of care minimal for most older adults. B) Payment for long-term care of adults is most often covered by private insurers. C) Most older adults have their basic care needs provided in a long-term facility. D) Overall, federal money pays for more care than do older adults themselves or private insurers.
Ans: D Feedback: Most money for the care of older adults comes from federally funded programs. The burden of payment is still significant for most older adults and a minority of older adults receive care in an institutional living environment.
A nurse who works on a subacute medical unit of a hospital is discussing the increasing population of older adults on the unit with a colleague. Which of the colleague's following statements about older adults is most accurate? A) "Fortunately, Social Security ensures a sufficient level of income for people over 65." B) "It helps that older people don't have to directly incur any costs for their medical care." C) "Most of the older clients on the unit will have come to us from nursing homes." D) "It's reassuring that people are starting to show more concern for older adults than in decades past."
Ans: D Feedback: The formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare all occurred in 1965. Since that time, society has demonstrated a growing concern for its older members. Myths about older people include the belief that Social Security ensures them an adequate income, that they do not have to pay for medical care, and that most older adults live in nursing homes.
Two related and important trends in the elderly population are: A) The growing gap in life expectancy between males and females and the number of women living alone B) The increase in life expectancy of white and black people. C) The continued burden of acute disease and the low levels of education among the elderly D) The increased burden of chronic illness and the shifting causes of death with advancing age
Ans: D Feedback: The role of chronic illness in death rates is both significant and represents a shift from the past. The gap in life expectancy between men and women is narrowing. The life expectancy of black people has been recently declining. The generation now entering the senior years is better educated than generations past.
