Care for the Older Adult DPV1

difference between ADLs and IADLs (instrumental activities of daily living)

Activities of daily living (ADLs): include activities of daily life such as bathing, dressing, transferring, walking, eating, and continence. Instrumental activities of daily living (IADLs): Activities related to independent living, they include meal preparation, money management, shopping, housework, and using a telephone. Nurses can use instruments to identify elderly individuals who benefit from an increased level of care or add support. Fear of being advised to leave their homes casue elderly individuals to deny difficulties. IADL scales rely on self reporting and can difficulties when clients are not forthcoming limitations.

IADLS (Instrumental Activities of Daily Living)

more complex activities. Laundry, shopping for groceries, using a telephone, cooking, shopping, housekeeping, finances, taking medications, preparing meals, fixing things around the house, lawn care,

Medicare

o 65 or over who have paid into the Social Security system, the railroad fund, or are diagnosed with end stage renal disease

Interdisciplinary Team

o Bring together diverse skills and expertise to provide more effective, better coordinate, and better quality services for clients

Medicaid

o Financed by state and federal governments, administered by state 1. Health insurance for low-income families and people with disabilities 2. Long-term care (LTC) for older Americans and persons with disabilities 3. Supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare

Health Promotion Efforts

of Healthy People 2010 and the USPSTF suggest that nurses focus on to promote health and prevent disability in the older adult (see pg 356) Physical activity Nutrition Tobacco use Safety Immunization

Center for Science in the Public Interest (CPSI

premier educational and advocacy organization for promoting better nutritional habits in the United States.

Healthy People 2000

reduce preventable death and disability for Americans

Types of Care Facilities

Acute Care Hospital (ACH) - point of entry into the health care system for older adults. Acute Rehabilitation (Rehab)- may be found in several settings. Uses the interdisciplinary team of nurses, therapists, and physicians. Goal is to maximize independence, promote maximal function, prevent complications, and promote quality of life within each person's strengths and limitations. Level of intensity depends on setting and patient. Home Health Care- For independent living home-bound adults who require a longer period of observation or care from nurses. Can include PT/OT, & speech therapy. Hospice- holistic, interdisciplinary care that helps the dying person "live until they die." Includes palliative care and pain management and comfort care. Long-term Care Facility (a.k.a. nursing home)- provides 24 hr support care to any age who have lost some or all their capacity for self-care due to illness, disability, or dementia Skilled Nursing Facilities (SNFs)- subacute or transitional care are for those patients requiring more intensive nursing care than provided in Long-term care. Alzheimer's Care- dedicated specifically for Alzheimer and Dementia care. Respite Care- provides time off for family members who are caretakers. Care can be at adult daycare center, in the home, or in an assisted living facility or LTC Continuing care retirement community (CCRC)- group care in independent living to assisted living, LTC, or skilled Assisted Living- alternative who do not feel safe living alone, who wish to live in a community setting, or who need some additional help with ADLs. They each have their own apartment or room. Foster care/Group Homes- adults who can do most ADLs but have safety issues and require supervision with some activities. Green House Concept- new concept of a home environment with 8-10 residents in private rooms with open kitchen and still receive assistance. Adult Day Care- Adult day services are community based group programs designed to meet the needs of functionally and/or cognitively impaired adults through and individual plan of care. Less than 24 hour care.

What are the five A's to tobacco cessation

Ask about smoking status at each health care visit Advise client to quit smoking Assess client's willingness to quit smoking at this time Assist client to quit using counseling and pharmacotherapy Arrange for follow-up within one week of scheduled quit date.

Types of Hearing Aids

BTE (Behind the ear)- 1 inch long and worn behind the outer ear. A small tube connects with the amplification device behind the ear and delivers amplified sound into the ear canl. The device has an adjustable volume control and is battery powered. It is the most common style of hearing aid. These devices are suitable for the entire range of hearing loss. OTE (Over the ear)- This is a new style that is very small and sits on top of the outer ear. ITE (in the ear)- ITEs are custom-fitted devices molded to the contour of the outer ear. The device has an adjustable volume control and a batter, however, both are much smaller than ones used in a BTE device. Some users have difficulty seeing or manipulating the control and battery. These devices are used for mild to moderate hearing loss. ITC (in the canal)- ITCs are tiny devices that fit into the ear canal and are barely visable. They are customized to fit the size and shape of the ear canal. Although cosmetically appealing, their small size is a drawback for some individuals. CIC (completely in the canal)- CICs are smallest type of device in the in-the-ear class. The entire device fits within the canal. Although cosmetically flattering, the small size is a true disadvantage because of difficulty handling and positioning the device. This device is the most expensive model of hearing aid.

five racial groups

Caucasian/non-Hispanic whites/European Americans African American Hispanic Asians and Pacific Islanders American Indians and Alaskan Natives

In most cases of elder abuse who is the perpetrator?

Elder Abuse may include physical, sexual psychological, and financial exploitation, neglect, and violation of rights. Most cases of elder abuse are perpetrated by a family member, and reasons for the abuse include caregiver burnout and stress, financial worries, transgenertional violence and psychopathology in the abuser. Women and dependent elders tend to be the most vulnerable to abuse.

I HATE FALLING risk assessment tool

Inflammation of joints or joint deformity Hypotension (orthostatic blood pressure change) Auditory and visual abnormalities Tremor Equilibrium problems Foot problems Arrhythmias, heart block, valvular disease Leg-length discrepancy Lack of conditioning (generalized weakness) Illness Nutrition (poor, weight loss) Gait disturbance Recommendations: Level B recommendation: Balance and strengthening exercise programs, home safety assessment, and training and medication monitoring and adjustment are recommended in order to reduce fall risk.

There are three types of assessments: Physical, Cognitive and Functional.

Physical assessment is assessing the patient's physical health. It included vital signs, assessing for pain, blood pressure problems, irregular heartbeat, abnormal breath sounds, etc. you know these because as a nurse you are always assessing the patient. In addition, for older adults you want to assess cognitive function. Functional assessment is assessing what the older adult can still for themselves. Bathing, eating, getting dress, brushing their teeth and more are functional abilities. Functional abilities can be altered due to physical impairment and illness. Dr. Katz and Dr. Barthel developed ADL/IADL indexes to measure the patient's functional abilities. You should have noticed that ADL is used throughout the book. This is because the ADL's can determine the patient's care plan. It determines whether they are safe in the current environment. It impacts their ability to participate in health promotion and disease prevention. Cognitive- thought processing, thinking and reasoning skills. Know the normal cognitive changes as a result of aging. Dementia is not normal. You will need to understand the difference between delirium & dementia.

Maslows Psychological Theories of Aging

Physiological Safety & Security Love & Belonging Selft-esteem Self-actualization

What is the criterion for the pneumococcal vaccine?

Pneumococcal vaccine is given once for clients who are 65 years of age or older. There is evidence to support one-time-only revaccination for clients 75 years or older who have not been vaccinated in 5 or more years.

What are the five R's to tobacco cessation

Relevance: Ask the client to think about why quitting may be personally relevant for him or her Risks of smoking are identified by the client Roadblocks or barriers to quitting are identified by the client Repetition of this process at every clinic visit. Most people who successfully quit smoking require multiple attempts.

Changes of aging that could affect therapeutic communication

Visual communication- position objects within their visual field. This includes positioning yourself within their visual field when speaking with the person. This helps the person to locate the object of conversation and to orient him or her to the topic of conversation. When assisting elders with their care needs, it may be useful to give them a verbal indication of the actions you are about to impart, so as to avoid startling or scaring them needlessly. It may be necessary to assist the person in labeling objects or to simplify what is in their visual field. Hearing communication- Do not shout. Project voice from the diaphragm (deepens tone). Make use of the person's other unipaired senses. Stand in front of them if they can lip read. Speak into the good ear. Make sure the hearing aid is turned on. Use gestures or objects to assist communication. Limit background noise. Allow adequate time for a response. Use short sentences and speak clearly. Enunciate words. Write things out. Speech Communication-individuals with speech or language difficulties might be more anxious or self-aware. Limit distractions, make eye contact, position yourself in front of the person. Use facial or body language. Use written communication. Use short complete sentences. Summarize message for accuracy. Take your time.

Respite Care

"respite" means to take a break. Short term intermittent care for person with chronic/debilitating care for person with chronic/debilitating conditions. For a care giver who is providing 24/7 care to anyone with continuous care needs, respite could mean taking the loved one to an agency over the weekend so that the caregiver can take a break from care giving, or having someone else come in to relieve the caregiver.

CAM (Confusion Assessment Method

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CSI (Caregiver Strain Index)-

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The Patient Protection and Affordable Care Act

1. Eliminate lifetime limits for health insurance coverage for essential services 2. Eliminate the ability of insurance companies to rescind coverage 3. Free Preventative care 4. Development of a prevention and public health fund. 5. Increase access to affordable care, including a provision for preexisting 6. Quality improvement and risk reduction

Four leading causes of death in the US

1. Heart disease 2. Cancer 3. Chronic lower respiratory diseases 4. Stroke 5. Accidents 6. Alzheimer's 7. Diabetes 8. Kidney Failure 9. Influenza & Pneumonia 10. Suicide

What are the signs of impending death?

1. Loss of appetite 2. Excessive fatigue and sleep 3. Increased physical weakness 4. Mental confusion or disorientation 5. Labored breathing 6. Social withdrawal 7. Changes in urination 8. Swelling in the feet and ankles 9. Coolness in the tips of fingers and toes 10. Mottled veins

Care Transitions 4 conceptual Domains/Pillars

1. Medication self management 2. Use patient-centered health record 3. PCP/Specialist f/u 4. Knowledge of red flags

Common Applications of Assistive Technology

1. Position and mobility 2. Environmental access and control 3. Self-care 4. Sensory impairment 5. Social interaction and recreation 6. Computer-related technology

SSI (Supplemental Security Income)

Additional monthly check for those at poverty level

Morse Fall Scale

An effective fall score tool

SPICES

An overall Assessment Tool of Older Adults. S is for Sleep Disorders. P is for Problems with Bathing or Feeding, I Incontinence, C is for Confusion, E is for Evidence of Falls, S is for Skin Breakdown

Gerontology

Study of aging; broad category that includes several areas (sociology of aging, psychology, economics of aging

Medical

California's Medicaid program

The Katz Index of ADLs

Developed by Dr. Katz. Distinguished between independence and dependence. Bathing, eating, dressing, transfer, toileting, and continence

Medication Adherence

Direct and indirect methods of assessing medication adherence can be utilized to identify elderly people having difficulty in adhering to prescribed regimens. Health care professionals can monitor blood levels and/or urine assays for drug metabolites or marker compounds. Indirect methods of assessing adherence include patient interviews, pill counts, refill records, medication organizers, and measurement of health outcomes.

Multidisciplinary teams

Function as a group (multiple) of professionals who work loosely in the same area or with the same client.

Social Security

Is "retirement income", based on work history

Kohlman Evaluation of Living Skills (KELS)

KELS is an Occupational Therapy evaluation that is designed to determine a person's ability to function in basic living skills. The administration of the evaluation combines interview questions and tasks

Risks for a sedentary life style

Lack of physical activity has clearly been shown to be a risk factor for cardiovascular disease and other conditions: • Less active, less fit persons have a greater risk of developing high blood pressure. • Studies indicate that physically active people are less likely to develop coronary heart disease than those who are inactive--even after the researchers accounted for smoking, alcohol use, and diet. • Lack of physical activity can contribute to feelings of anxiety and depression. • Physical inactivity may increase the risk of certain cancers. • Physically active overweight or obese people significantly reduced their risk for disease with physical activity. • Inactivity tends to increase with age. • Women are more likely to lead sedentary lifestyles than men. • Non-Hispanic white adults are more likely to engage in physical activity than Hispanic and non-Hispanic black adults

Beers' List of Inappropriate drugs for Older Adults

Make sure you are familiar with this. Benzodiazepines are mentioned quite a bit. It is estimated that 1/5 of clients are prescribed medications that are not BEERS List of Medications to Avoid in the Elderly Medication Effect Propoxyphene (Darvon) and combination products (Darvon with ASA, Darvon-N, and Darvocet-N) Offers few advantages over acetaminophen, yet has the same adverse effects as other narcotic medications Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amytriptyline (Triavil) Strong anticholinergic and sedation effects Diphenhydramine (Benadryl) May cause confusion and sedation; use in smallest possible dose for emergency allergic reactions All barbiturates, except when used to control seizures Highly addictive, more adverse effects in the older adult Meperidine (Demerol) May cause confusion Short-acting nifedipine (Procardia and Adalat) Potential hypotension and constipation Clonidine (Catapres) Potential for orthostatic hypotension and CNS adverse effects Mineral oil Potential for aspiration and adverse effects; other options readily available Estrogens only Lack of cardioprotective effect in older women; evidence of carcinogenic potential Nitrofurantoin (Macrodantin) Potential for renal impairment; other alternatives available Cimetadine (Tagamet) CNS effects including confusion Indomethacin (Indocin and Indocin SR) CNS adverse effects; other NSAIDs available with fewer adverse effects Methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxaxone (Paraflex), cyclobenzaprine (Flexeril), oxybutynin (Ditropan) Anticholinergic effects, sedation, weakness Short-acting dipyridamole (Persantine) Orthostatic hypotension Methyldopa (Aldomet) and methyldopa-hydrochlorothiazide (Aldoril) May cause bradycardia and exacerbate depression in older adults

Borg Category Rating Scale

Measures perceived exertion. It is used to document the patient's exertion during a test, and sports coaches use the scale to assess the intensity of training and competition.

The Independence at Home Demonstration

NP's worked with patients to help them experience a higher level of independence through better management of their chronic illnesses Provisions that have already taken effect: 1. Improved drug discounts for Medicare recipients 2. Coverage for young adults through parental health insurance until age 26. 3. Expanding coverage for early retirees 4. National preexisting-condition insurance plan to assist those individuals without coverage for at least 6 months due to a prior condition. 5. 2012 mandate The US Supreme Court upheld provisions to expand Medicaid and Medicare coverage a. The Medicare expansion program requires participating states to expand coverage to most individuals under the age of 65 with income below poverty levels outlined in the Act. 6. The intent of PPACA in terms of Medicare is to reduce overall cost while maintaining coverage to those entitled to Medicare. 7. A national Medicare pilot program will be developed to provide Medicare recipients with more options for long-term care, including primary care services in their homes rather than institutional care. 8. Increase services that will impact the older population include providing wellness and prevention programs at no cost to the individual and prescription drug discounts.

Age

Old Old= 85+ years Older Adult= 65 years of age or older

Ageism

Prejudice towards elderly

What is role reversal for the older adult?

Role reversal is where the children take care of the parents

Triple Aim of healthcare reform

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI's belief that new designs must be developed to simultaneously pursue three dimensions, which we call the "Triple Aim": • Improving the patient experience of care (including quality and satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care.

Polypharmacy

The act of taking many medications concurrently

Healthwise

The best known older adult medical self-care program is Healthwise, located in Boise, Idaho.

Geriatrics

The branch of medicine concerned with the problems of aging

Barthel Index

This index was designed to measure functional levels of self-care and mobility and it rates the ability to feed and groom oneself, bathe, go to the toilet, walk (or propel a wheelchair), climb stairs, and control bowel and bladder.

Geriatrician

a physician, board certified in geriatrics, who specializes in the care of the elderly

GDS (Geriatric Depression Scale)

a set of 30 questions to assess for geriatric depression. A "negative" response which, depending on the question may be a yes or no answer, is scored as one point; a higher score indicates more symptoms of depression

Living Will

alternative documents that direct preferences for end-of -life care issues, providing an "if...then..." plan

Baby Boomers

are aging adults born from 1946-1964. They will reach retirement starting around 2011-2030.

Alzheimer's

betaamyloid plaques and neurofibrillary plaques

International Classification of Impairment, Disability and Handicap (ICIDH

cover those expenses of long-term care that are not covered by traditional health insurance or Medicare.

Long-term Care

cover those expenses of long-term care that are not covered by traditional health insurance or Medicare.

MMSE (Mini Mental State Examination)-

differentiate organic from functional disorders and to measure change in cognitive impairment. It is not used for diagnostics. It measures orientation, registration, attention and calculation, short-term recall, language, and visuospatial function

Advanced Directives

helps an individual identify their personal wishes in a legal manner and to share that information with the people around them, including medical personnel.

Satir's Basic principles for Communication

invite, arrange, environment, maximize communication, maximize understanding, and follow through

Healthy People 2010

is an initiative of the U.S. Dept. of Health and Human Services that utilized the skills and knowledge of an alliance of more than 350 national organizations and 250 state public health, mental health, substance abuse, and environmental agencies to develop a set of health care objectives designed to increase the quality and quantity of years of healthy life of Americans and to eliminate health disparities.

Mini-Cog

is another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT)

Dysarthria

is disturbed articulation caused by disturbance in the control of the speech muscles. This disturbance is caused by brain lesions in motor areas in the central nervous system or the brain stem or disruption in the coordination of information from the basal ganglia, cerebellum, and motor neurons. Dysarthria-related lesions can be caused by stroke, brain tumor, degenerative diseases, metabolic diseases, or toxins. The location of the brain lesion determines the nature of the disturbance, which can manifest in many ways, with the most severe form being anarthria (complete inability to move the articulators for speech). People with dysarthria may present with slurred speech, breathiness, slow or rapid rate of speech, limited mouth or facial movement, monotonous voice, or weak articulation. A person who has dysarthria may be able to read, write, and gesture normally and comprehension may remain intact

Frailty

is the common geriatric syndrome that embodies an elevated risk of catastrophic decline in health and function among older adults. • Characteristics of Frailty include Sarcopenia (loss of muscle mass), Osteoporosis, Muscle Weakness • To prevent Frailty maintain a healthy weight and diet, stay active, Practice fall prevention, make connections—maintain relationships with others, see drs regularly

Aphasia

is the most common language disorder in the elderly and occurs in up to a third of the patients in an acute phase following stroke. Aphasia is an inability to express or understand the meaning of words due to damage in the language areas. Damage is most frequently due to stroke in the left hemisphere, but can be due to brain tumor, trauma, infection, dementia, or surgery. In addition to spoken language, writing, reading, and the ability to gesture also may be impaired

Hospice Care

life expectancy of less than 6 months. • Hospice provides care and support for persons in the last phases of incurable disease so they may live as fully and comfortable as possible • Palliative Care philosophy of whole person care for those persons with life-limiting illnesses who are not yet eligible for hospice support

DNR (Do Not Resuscitate)

life-prolonging procedures declaration are all legally recognized documents for indicating one's health care wishes

AAC (Augmentative and Alternative Communication)

refers to all forms of communication that enhance or supplement speech and writing, either, temporarily or permanently. AAC can both enhance (augmentative) and replace (alternative) conventional forms of expression for people who can't communicate through speech, writing, or gestures.

AADLs (Advanced Activities of Daily Living)-

social, family, and community roles, occupation

Autonomy

the concept that each person has a right to make independent choices and decisions

Self-Determination-

the patient's right that is the right to decide.

MAP

this means medication assistance program and it will be mentioned in a later chapter. Make sure you understand what it is. This is a choice you can offer your patient who cannot pay for their medication.

MCSI (Modified Caregiver Strain Index):

tool that can be used to quickly screen for caregiver strain with long-term family caregivers. It is a 13 question tool that measures strain related to care provision.

U.S. Preventive Services Task Force (USPSTF)

was convened by the U.S. Public Health Service to systemically review the evidence of effectiveness of clinical preventive services. The task force is an independent panel of private-sector experts in primary care and prevention whose mission is to evaluate the benefits of individual services ant to create age, gender, and risk based recommendations about services that should routinely be incorporated into primary medical care.

What are some of the preventive care services covered under Medicare

• Abdominal aortic aneurysm screening • Alcohol misuse screenings & counseling • Bone mass measurements (bone density) • Cardiovascular disease screenings • Cervical and vaginal cancer screening • Colorectal cancer screening • Depression screenings • Diabetes screenings • Obesity screenings • Prostate screenings • STI screenings and counseling • Shots: Flu, Hep B, Pneumococcal • Tobacco cessation

What is the one of the most common role changes faced by the aging person

• Changing from a parent to a grandparent

Tips of medication Review

• Current prescription medications • Current over-the counter- and herbal medications, and frequencies • Social drug use (i.e. alcohol, tobacco, caffeine) • Home remedies • Drug allergies • Compliance assessment • Medication administration (need for special devices, patient's mental status, caregiver administration.

physiological changes that occur which make the older adult more susceptible to adverse drug reactions.

• Digestive system fewer digestive enzymes and juices produced. Peristalsis decreased causing constipation/flatulence. Loss of teeth. Liver functions decrease. Dysphagia often occurs. Less saliva and slower gag reflex leads to chocking. Poor appetite due to less taste sensation. • How to help Good oral hygiene and repair of damaged or lost teeth. Relaxed atmosphere when eating. Avoid dry, fried or fatty foods (difficult to digest) Offer high fiber and high protein foods. Use seasonings to help taste. Increase fluids to help swallowing. • Endocrine system Increased production of some hormones and decreased production of other hormones. Immune system less effective so get sick easier. Cold, tired, less alert due to metabolic rate decrease. Increased blood glucose levels due to intolerance to glucose due to intolerance to glucose. Usually occurs gradually. • How to help: Proper exercise, rest and medical care for illness. Balanced diet. Healthy lifestyle to decrease the effects caused by changes in the hormones. • Nervous system changes here affect other areas. Decrease blood flow causes progressive loss of brain cells. Due to above, interferes w/thinking, reacting, interpreting and remembering. Sense decreases-longer to feel pain, less taste. May have memory loss, especially short term. More prone to cataracts (lens become cloudy) and glaucoma (intraocular pressure increases) Hearing loss usually gradual and more prone to high tones. • How to help Be patient. Proper eye and hearing care—may need special phones for seeing numbers or hearing tones. Speak slowly and clearly, eliminated background noise. Arrange meals attractively. Environmental safety—smoke detectors, safety bars, etc. • Integumentary system Most obvious effect seen here sebaceous and sudoriferous glands less active. Circulation decreases. Skin less elastic, itching is common, senile lentigines appear (dark yellow/brown spots). Increased sensitivity to temperature • How to help: Good hygiene. Frequent use of bath oils/lotions. Decrease showers/baths to weekly. Keep injuries clean and free of infection. Layer clothing to help with cold. No hot water bottles/heating pads. • Respiratory system Muscles become weaker, rib cage becomes more rigid, Alveoli becomes thinner and less elastic. Chronic conditions: emphysema, bronchitis, dyspnea. • How to help Alternate activities with periods of rest. Proper body positioning. Sleep in semi-fowlers position. Avoid smoke-filled rooms • Urinary system Kidneys decrease in size and become less efficient. Loss of ability to concentrate urine causing loss of minerals and electrolytes. Nocturia is common. Enlargement of prostate gland makes urination difficult. Incontinence due to loss of muscle tone. Dehydration can occur because individuals decrease intake thinking they will urinate less. • How to help: Encourage fluids to decrease kidney infections. Regular trips to the bathroom (bladder training) Drink most fluids prior to 7 pm. • • Musculoskeletal system muscles lose tone, volume and strength. Osteoporosis occurs from mineral loss. Joints become stiff, less flexible and sometimes painful. Movement is slower. Fine motor movements become more difficult. • How to help: Encourage exercise to keep muscles active (range of motion). Diet high in protein, calcium and vitamins to slow mineral loss and help muscle strength. Enviromental safety-grab bars, canes, etc. Well fitting shoes. Consult w/ therapy for latest tx. • • Circulatory system Heart muscle less efficient. Vessels narrow and less elastic. Blood flow to brain decreases due to efficieny. Blood pressure may increase. • How to help: Avoid strenuous activities. Moderate exercise, low impact. Support hose to prevent blood clots. Range-of-motion exercise. Diet low in salt/fat. • Changes in Cognitive Decline in information processing speed, divided attention, sustained attention, ability to perform visuospatial tasks, and short-term memory • Changes in Hearing Conductive problems Sensorineural problems. Presbycusis. Results in loss in sensitivity to pitch with high-frequency consonants, poor word recognition • Changes in Touch Reduction in number of receptors. Reduction in blood flow. Results in a reduction in tactile and vibration sensations, decreased sensitivity to warm or cold stimuli • Changes in Vision Changes in lens, pupil, and iris. Results in poor visual acuity, Presbyopia, increased sensitivity to light and glare.

Framingham Heart Study.

• FHS is a long term, multigenerational study, designed to identify genetic and environmental factors influencing the development of cardiovascular and other diseases. • Age Greater than or equal to 50 for men and 60 for women • Hypertension • Smoking • Obesity • Family History of premature CHD • Diabetes • Sedentary lifestyle • Abnormal lipid levels

Falls & Safety

• Falls are the leading cause of unintentional injury death in older adults in this country. Elderly adults are susceptible to falls as a result of postural instability, decreased muscle strength, gait disturbances and decreased propriocepton, visual and or cognitive impairment, and polypharmacy. Environmental conditions that contribute to falls are slippery surfaces, stairs, irregular surfaces, poor lighting, incorrect footwear, and obstacles in the pathway.

Common signs of abuse

• Financial exploitation • Physical abuse • Neglect • Emotional abuse

Health promotion vs. health screening.

• Health promotion are activities in which an individual is able to proactively engage in order to advance or improve his or her health • Health screening

Risk factors for stroke

• High blood pressure • Atherosclerosis • Heart disease • Smoking or tobacco use • Atrial fibrillation (Afib) • Diabetes • Overweight or Obesity • Blood disorders • Excessive alcohol • Certain medications

List and describe the care options for the older adult

• Independent living with help: Cooks, companions, homemaker/cleaning service—formal or informal. • Family: Usually informal; may live in patient's or family member's home • Adult daycare at a facility: Part-time temporary assistance, frequently for respite or while a family caregiver works; often used for persons with dementia or for the frail elderly needing assistance or at risk for social isolation. Usual discharge is to assisted living or death. • Adult daycare at home:Part-time respite, as above. • Senior living complexes/continuing care/supported care retirement communities: Full range or limited services, depending on the community and level of assistance needed; can be progressive as needs increase. • Assisted living: Homelike setting with more physical and medical care availale than in senior complexes. • Paid caregiver homes (licensed or unlicensed): Caregivers accept one or several non-relatives into their home to receive 24 hour assistance, especially with BADLs, usually on a private-pay basis. In some states, public subsidies may cover adult group/foster home care • Extended care facilities: Skilled or intermediate care nursing home facilities for rehabilitation or ongoing care; can be paid by Medicare, Medicaid, or private pay, depending on financial resources. Pre-admission screening is usually required by the state regulatory agency.

What are the factors that influence the quality of life of an older adult

• Quality of Life is an individual's perception of his or her position in life in the context of the culture and value system where they live and in relation to their goals, expectations, standards and concerns. It is a broad-ranging concept, incorporating a person's physical health, psychological state, level of independence, social relationships, personal beliefs and relationships to salient features in the environment.

Five Rights of Medication Administration

• Right Drug • Right Amount • Right Route • Right Time • Right Person

Malnutrition lab values

• Serum Prealbumin <15 mg/dl—best marker for malnutrition • Serum Albumin <3.4 mg/dl • Serum Transferrin <200 mg/dl • Total Lymphocyte Count < 1500/mm3

Robotic Assistance

• Intelligent reminding: many older adults have to give up independent living because of memory loss. They forget to visit the restroom, to take medicine, to drink, or to see the doctor. One project explores the effectiveness of a robotic reminder, which follows people around, so they can't become lost. • Tele-presence: Professional caregivers can use the robot to establish a "tele-presence" and interact directly with remote care recipients. This makes many doctor visits unnecessary. • Data collection and surveillance: Robots can be used for a wide range of emergency conditions that can be avoided with systematic data collection (e.g. certain types of heart failures). • Mobile manipulation: A semi-intelligent mobile manipulator integrates robotic strength with person's senses and intellect. This mobile manipulation can overcome barriers in handling objects (i.e refrigerator, laundry and microwave) that currently force older adults to move into assisted-living facilities. This technology could be used for any person dealing with function problems, such as arthritis, as the main reason for giving up independent living. • Social interaction deprivation: This affects a huge number of elderly people who are forced to live alone. This project seeks to explore whether robots can take over certain social functions for these older adults.

Risk Factors for Falls

• Intrinsic risk factors- relate to the changes associated with aging and with disorders of physical functions needed to maintain balance. These functions include vestibular, proprioceptive, and visual function as well as cognition and musculoskeletal function. • Extrinsic risk factors- are related to environmental hazards and challenges such as poor lighting, stairs, clutter, and throw rugs. Extrinsic factors are implicated in up to 50 % of all falls in the elderly in community settings.

Chronic disease self-management program (CDSMP)

• Is a 17 hr course for patients with chronic disease taught by trained lay people. The course goal is to improve symptom management, maintain and adhere to their medication regimens. The effectiveness of the intervention is, at least in the improved self-efficacy of clients who pay for the program. Clients come to believe that they can manage their illness and prevent disabilities. Five key elements of self-management programs are: problem solving, decision making, resource utilization, care professional/client partnership and take

General guidelines to dietary counseling.

• Limit alcohol to one drink a day for women, two daily for men • Limit fat and cholesterol • Maintain a balanced caloric intake • Ensure adequate daily calcium, especially for women • Older adults should consume vitamin B12 in crystalline form, which can be derived from fortified cereals and supplements • Older adults who have minimal exposure to sunlight or who have dark skin need supplemental vitamin D. Daily vitamin D intake should be 400-600 IU and can be derived from fortified foods or supplements. • Include adequate whole grains, fruits, and vegetables • Drink adequate water

Risks for poor nutrition

• Multiple chronic illness, may have tooth or mouth problems that may interfere with their ability to eat, may be socially isolated, may have economic hardship, may be taking medications that can cause changes in appetite or gastrointestinal symptoms, and may need assistance with self-care • Depression and dementia are both risk factors for nutritional compromise

What are other disease processes the older adult is at risk for?

• Osteoporosis Age, low BMI, and failure to use estrogen replacement are the strongest risk factors for osteoporosis development. The risk associated with agae alone was high enough that the USPSTF recommends routine screening for all women over the age of 65. If risk factors, especially weight less than 70 kg ( about 154 lbs) and no estrogen therapy, are present, the task force suggest screening women at age 60. • Prostate Cancer Two tests are commonly used in prostate screening: the digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. • Decreased Metabolism with age, hepatic mass and blood flow decrease. Therefore, the hepatic metabolism of medications is reduced. Also with age, the renal mass and renal blood flow are reduced. This physiologic change will decrease the amount of drug that goes through renal excretion. This can result in higher, and potentially toxic, levels of drug in the body of the older adult • Cardiovascular Structural changes with age: Decreased myocardial cells, decreased aortic dispensability, decreased vascular tone. Increased myocardial cell size, increased left ventricle wall thickness, increased artery stiffness, increased elastin levels, increased collagen levels, increased left atrium sized. Functional changes: Decreased diastolic pressure (during initial filling), decreased diastolic filling, decreased reaction to B-adrenergic stimulus. Increased systolic pressure, increased arterial pressure, increased wave velocity, increased left ventricular end-diastolic pressure, elongation of muscle contraction phase, elongation of muscle relaxation phase, elongation of ventricle relaxation. No change with age: Ejection fraction, stroke volume, overall systolic function

Alternatives techniques to restraints

• Personal strengthening and rehabilitation program • Use of personal assistance devices such as hearing aids, visual aids, and mobility devices • Use of positioning devices such as body and seat cushions or padded furniture • Safer physical environment design, including removal of obstacles that impede movement, placement of objects and furniture in familiar places, lower beds, and adequate lighting • Regular attention to physical and personal needs, including toileting, thirst, hunger, socialization, and activities adapted to current ability and former interests • Design of physical environment for close observation by staff • Efforts to increase staff awareness of a person's individual needs, including assignment of staff particularly to the person, in an effort to improve function and decrease difficult behaviors • Living environment designed to promote relaxation and comfort, minimize noise, provide soothing music, and maintain appropriate lighting • Provision of massage, art, movement activities, and complementary therapies (e.g. Healing Touch, energy work) • Use of bed, chair, and door alarms to alert to the need for assistance

Types of restraints

• Physical • Chemical

Three types of prevention

• Primary prevention are activities that are designed to prevent disease from occurring, such as immunization against pneumonia or influenza. • Secondary prevention are efforts are directed toward early detection and management of disease, such as the use of colonoscopy to detect small, cancerous polyps • Tertiary prevention are efforts used to manage clinical disease in order to prevent them from progressing or to avoid complications of the disease, as is done when beta blockers are used to help remodel the heart in congestive heart failure.

•List the nutritional assessment tests to determine risk for diet-related chronic illness

• Serum albumin: Less than 3.5 g/dl is associated with malnutrition and increased morbidity and mortality. Malnutrition= serum albumin below 3.5. • Body mass index (BMI): The Nutrition Screening Initiative suggests that a BMI of 22-27 is considered normal. Values above or below this range suggest over- and underweight, respectively. Unintended weight loss is a nutritional risk that requires additional assessment. Obesity is a problem for many older Americans, just as it is for younger adults. The Obesity Education Initiative of the National Heart, Lung, and Blood Institute (2005) has provider guidelines and patient education materials (http://www.nhlbi.nih.gov/about/oei/index.htm). • Adult Treatment Panel (ATP III) Cholesterol Guidelines: An unintended decrease in cholesterol to less than 150 mg/dl is a nutritional risk (http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm). • ADL and IADL measures: These can assess a client's ability to eat and prepare food and to do the shopping and transportation necessary for good nutrition. • Dietary Reference Intakes and Recommended Daily Allowances: These can be compared with food diaries from a 24- to 48-hour period to assess marked deviation from these guidelines. Clients who use many vitamin and nutritional supplements may be at risk for toxicities. • Depression and dementia: Both are risk factors for nutritional compromise.

health contract

• The client is helped to choose an appropriate behavior change goal and to create and implement a plan to accomplish that goal. The statement of the goal and the plan of action are then written into a contract format.

Alcohol abuse

• The prevalence of alcohol abuse by community-dwelling elderly in the United States is largely unknown, but 6% to 11 % of elderly adults admitted to hospitals are found to have problems with alcohol • CAGE Questionnaire is a self report screening instrument that is easy and quick to administer. It asks four yes/no questions. Cut down, Annoyance, Guilt, Eye opener

Guidelines for Introducing Technology and Teaching the Elderly About Its Use

• The use of technology must be perceived as needed and meaningful, and must be linked to the lifestyle of the person. • •Cautions and disbelief in one's capability may be an obstacle in accepting new technology and must be considered when creating the learning environment. • A generous amount of time as well as repeated short training sessions should be allowed. 1112 • •More stress should be placed on the practical application of the device than on its technical features. • Only selective, central facts should be presented. • Sessions should be held in the home or natural meeting places of the elderly. • The instructor should be well known by the elderly or introduced well in advance of the training. • The attitudes of the instructors toward the aged must be positive and realistic.

Assistive technology

• any item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities • These devices include the entire range of supportive tools and equipment, from adapted spoons to wheelchairs and computer systems for environment control. • There is a loss of strength, balance, visual and auditory, cognitive, and/or memory changes that occur as we age. Assistive technology is designed to help us with these losses & bridge the gap between capabilities and care needs. • It is anything that can enhance the function of some physical or mental ability that is impaired. It can be a cane, walker, glassed, hearing aids, wheelchair, bath bench, elevated toilet seat. All of this is assistive technology. It is filling the functional gap. 87