N308 Chapter 5: Chronic Illness and Older Adults (Exam 1)
Other options for long-term care of older adults includes ___1___ living facilities and ____2___ living facilities. --____1______ living facilities includes housekeeping and meals being available. --______2_____ living facilities is for people who can somewhat do their own things but still need help. They offer assistance with ADLS, medications, transportation, etc. but the patient is okay to be in their room by themselves and can pretty much move around freely and don't need as much help as those in nursing homes
1) independent 2) assisted
With older adults, at the age of ______: Men have an additional life expectancy of 17.8 years (83 yrs) Women have an additional life expectancy of 20.4 years (85 yrs)
65
An appropriate care choice for an older adult who lives with an employed daughter but needs help with activities of daily living is a. adult day care b. long term care c. a retirement center d. an assisted living facility
A
With Medicare coverage is limited. Part _____ is free but only covers hospitilization.
A
An ethnic older adult may feel a loss of self worth when the nurse: (select all that apply) a. prohibits visits from a faith healer b. informs the patient about ethnic support services c. allows a patient to rely on ethnic health beliefs and practices d. emphasizes that a therapeutic diet does not allow ethnic foods e. has to use an interpreter to provide explanations and teaching
A,D
ADLs or IADLS: bathing, dressing, eating, toileting, and transferring
ADLs
• Federal agency o Department of Health and Hospitals o Provides funding and services for social support for the elderly
Administration on Aging (AoA)
• Community environment • Supervision/safety • Socialization (games, music, gets in groups to talk) • Assistance with ADLs • Meals • State regulations and standards • Delay institutional placement o Adult day care and adult day care can delay institutional placement o It can help with patients staying in their home or a family member in home for a longer period of time before going to a nursing home • Difference between _____ _____ ____ ___ ____ ___ ___ ____: Adult day health care provides some services like medication administration;
Adult Day Care and Adult Day Health Care
What chronic disease is described below: -affects 5.4 million people -6th leading cause of death
Alzheimer's disease
• Aka Council on Aging • State and local agencies funded thru AOA o Provide home making services where they send someone to do housekeeping, prepare meals, etc.
Area Agency on Aging
What chronic disease is described below: -affects 1 in 5 people -one of most common chronic illnesses
Arthritis
Examples of primary prevention strategies include: a. colonscopy at age 50 b. avoidance of tobacco products c. teaching the importance of exercise to a patient with HTN d. intake of a diet low in saturated fat in a patient with high cholesterol
B
With medicare coverage is limited. Part _____ you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part ____ also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic).
B
Medicare Advantage Plans, sometimes called "Part ____" or "MA Plans" are offered by private companies approved by Medicare to provide Part A and B benefits
C
Nursing interventions directed at health promotion n the older adult are primarily focused on a. disease management b. controlling symptoms of the disease c. teaching positive health behaviors d. teaching regarding nutrition to enhance longevity
C
A characteristic of a chronic illness is that it (select all that apply): a. has reversible pathologic changes b. has a consistent, predictable clinical course c. results in permanent deviation from normal d. is associated with many stable and unstable phases e. always starts with an acute illness and then progresses slowly
C,D
What chronic disease is described below: -affects about 17 million adults -leading cause of death
CAD (coronary artery disease)
What chronic disease is described below: leading cause of death
CAD (coronary artery disease)
Older adults who become ill are more likely than younger adults to: a. complain about the symptoms of their disease b. refuse to carry out lifestyle changes to promote recovery c. seek medical attention because of limitations on their lifestyle d. alter their daily living activities to accommodate new symptoms
D
Part ___ is available to Medicare enrollees and provides a prescription drug benefit
D
What chronic disease is described below: -50,000 new cases each year -affects > 1 million Americans
HIV/AID
ADLs or IADLS: using a phone, shopping, handling finances, preparing food, housekeeping, doing laundry, arranging transportation, and taking medications
IADLs
Only those who PAY SOCIAL SECURITY are eligible for ?
Medicare
Acute or Chronic? --Rapid onset -- Short duration (don't last more than a couple of weeks)
acute
Acute or Chronic? o Complications infrequent o Return to previous level of functioning
acute
Acute or Chronic? o Rapid onset o Short duration (don't last more than a couple of weeks) o Self-limiting (go away without treatment over time) o Responsive to treatment (get an infection, take antibiotic, and it goes away) o Complications infrequent o Return to previous level of functioning
acute
Acute or Chronic? o Responsive to treatment (get an infection, take antibiotic, and it goes away)
acute
Acute or Chronic? o Self-limiting (go away without treatment over time)
acute
What stage of chronic illness trajectory is described below: -active illness with severe and unrelieved symptoms or complications -hospitalization may be required for management
acute (3)
o Discrimination against people based on age which can lead to health care disparities o EX: "they are too old to take chemo" o Negative attitude based on age **attitude toward aging
ageism
1. During a nursing _____ of an older adult, attend to primary needs FIRST. Comfort, toileting, eyeglasses, hearing aids DO you need to use the bathroom? Do you have pain? Are you comfortable? 2. Place all assistive devices such as walkers within reach. 3. Assess your patient's level of fatigue and pause the interview if necessary. Allow adequate time to offer information and time for the family to respond to any questions. 4. Interview both the older adult and his or her family or caregivers. This can be done separately, unless the patient is cognitively impaired or specifically requests the caregiver's presence.
assessment
A comprehensive geriatric ________ is interprofessional, and includes the medical history, functional assessment, medication review, cognitive and mood evaluation, social resources, physical exam, followed by recommended diagnostic tests. The interprofessional team minimally includes a staff nurse, an HCP such as a physician or adult-geriatric NP and a social worker. IT may also include a PT or OT therapist, dietitian, podiatrist, dentist, etc. o medical history (all medicines) o functional assessment are they able to handle ADLs on their own such as laundry, shopping by themselves? o medication review o cognitive and mood evaluation different tools we can use such as the Mini Mental Status exam done by NP or by a home health agency nurse depression scales done by HCP o social resources do they have family close by? Frequent interactions with friends? o physical examination risk for falls thorough skin assessment meaning taking clothes off and looking. You want to look in all of skin folds, look under breasts, buttocks, knees, etc.
assessment
During a nursing ______ of an older adult, the purpose is to determine appropriate interventions to maintain and enhance the health, quality of life, function, and independence of older adults.
assessment
Potential to increase function Can assist with rehabilitation and living with functional impairments Includes: • Canes • Walkers • Hearing aids and eye glasses • Adaptive devices: elevated toilet seats, eating utensils • Medical alert devices, electronic monitoring devices **nursing implementation
assistive devices
The following is _____ toward aging: • Aging is normal and is not an illness o Only 1 way to avoid getting older • Diverse o People age differently and have diverse characteristics • Care should be based not on age alone • Myths and stereotypes o Can lead to poor care • Ageism o Discrimination against people based on age which can lead to health care disparities o EX: "they are too old to take chemo"
attitudes
In older adults, disease symptoms are often _______ meaning the older adults do not feel same symptoms as younger patients would. They may underreport symptoms and "treat" these symptoms by altering their functional status. They fear of losing their independence and do not want to talk about their health problems.
atypical
the most common ________ illness presentations are 'delirium" or "acute change in mental status" and change in functional status. A caregiver may say that their relative is "acting differently," "doesnt appear as him/herself," or is no longer participating in usual activities or self-care. Sometimes the family member will come and say they are "not acting right" that should be a red flag; something is wrong
atypical
From a _____ view, aging reflects the changes that occur over time. ______ aging is a mutlifactorial process involving genetics, diet, and environment. In part, _____ aging can be views as a balance of positive and negative factors. Negative: stress, cancer, CV disease, diabetes, obesity Positive: exercise, good nutrition, social support, stress management, coping resources
biologic
What chronic disease is described below: -2nd leading cause of death
cancer
Are challenging those with multiple health conditions are particularly at high risk for Rehospitalization Medicare regulations require a RN, social worker, or qualified person to develop a care transition plan for patient discharge safe and effective care transitions are most likely to occur when interprofessional team members work together with the patient and family to coordinate care **Nursing implementation of older adults
care transitions
A patient with a chronic illness has to learn about adjusting to ______ in the course of the disease. This includes: • Course may be unpredictable • May worsen over time • Prescribed treatments may change/become more intense and burdensome • Personal identity to include chronic illness and impact on life o Need to start thinking of themselves having DM for example
change
Drugs used to restrict the freedom or movement of a patient or in some cases to sedate a patient Used ONLY to ensure safety Least restrictive approach Last resort with the care of older adults Determine unmet physiologic or psychosocial needs Highly regulated
chemical restraints
Acute or Chronic? o Irreversible pathologic changes (to body systems)
chronic
Acute or Chronic? o Prolonged (lasts 3 months or more) o Do not resolve spontaneously
chronic
Acute or Chronic? o Special rehabilitation o Long-term nursing/medical management
chronic
• Alzheimer's disease • Arthritis • Cancer • COPD/Asthma • CAD • Diabetes • Heart Failure • Obesity • HIV/AIDS • Kidney Disease • Many autoimmune diseases These are examples of acute or chronic disease?
chronic
What special population of older adults is described below: o 3x more likely to develop a chronic illness after age 45 o After 45, the chances of developing a chronic disease goes up each year
chronically ill
What stage of chronic illness trajectory is described below: -gradual return to an acceptable way of life
comeback (4)
When providing _____ care to older adults: • Cultural competence o Same as for all clients • Ethnogeriatric described the specialty area of providing culturally competent care to older adult patients
competent
To ______ symptoms of chronic illnesses the patient should adhere to: • Prescribed treatments o If they have to check blood sugar, prepare insulin, and administer insulin they need to plan that into schedule so they can manage that. • Lifestyle
control
What stage of chronic illness trajectory is described below: -life-threatening situation occurs -emergency services are necessary
crisis (5)
Not a normal part of aging More common in institutionalized older adults Second highest rate of suicide occurs in those over 75 Occurs together with medical conditions Caregivers also at risk **nursing implementation of older adults
depression
Pathologic conditions with similar symptoms are often confused. For example, _______ may be misdiagnosed and treated as dementia. _______ is more common; part of this has to do with changes in brain chemistry and part of this has to also do with increasing health concerns and social isolation. • They have more trouble with ADLs (more likely to have arthirits and mobility issues **atypical symptoms of older adults
depression
With ______ in an older adult, the nurses role is to assess, report, and refer.
depression
What chronic disease is described below: -affects > 29 million Americans -8.1 million do not know they have the disease -7th leading cause of death
diabetes
What stage of chronic illness trajectory is described below: -gradual and progressive deterioration in physical or mental status -accompanied by increasing disability and symptoms -continuous alterations in everyday life activities
downward (7)
What stage of chronic illness trajectory is described below: -patient has to relinquish everyday life interests and activities, let go, and die peacefully -immediate weeks, days, hours preceding death
dying (8)
The following falls under the legal and _____ issues with older adults: • Complex • Difficult decisions • Role of the nurse: o Stay informed about concerns with patient as well as family concerns o Be knowledgeable about resources available in the community o The REAL RULE is to be--> Advocate for patients and resolution
ethical
________ issues related to end-of-life care include decisions about resuscitation, treatment of infections, nutrient and dehydration, and transfer to more intensive treatment units
ethical
After implementation is _______. • Change in condition o ADLs, IADLs, mental status, or signs and symptoms of the disease • Perception of improved health o Does the client feel health has improved • Perception of the plan o Do the client and caregivers feel the plan is worth the time/effort/expense • Document positive changes to support the plan o Or indications to revise the plan
evaluation
What form of elder mistreatment and abuse is described below: move patient in the home for the purpose of getting access to social security check and spend it on themselves and not on the patient Or patient has a significant amount of savings Manifestations: living situation below level of personal resources, sudden change in personal finances, sudden transfer of assets
exploitation
What special population of older adults is described below: • is when they are no longer able to fully care for themselves • Clinical manifestations o Unintentional weight loss o Fatigue, exhaustion o Weakness o Slow walking speed o Low physical activity level o Poor nutrition SCALES nutritional assessment • Sadness or mood change • Cholesterol higher • Albumin lower • Loss or gain of weight • Eating problems (ex: mechanical problems such as impaired swallowing, poor dentition) • Shopping (food prep) problems
frail
What category of the elderly has chronic conditions and are not independent with ADLs? * usually over age of 75 and has physical, cognitive, and/or mental conditions that may interfere with independently performing ADLs
frail old
What chronic disease is described below: -most common reason older adults are hospitalized
heart failure
• Caregiver involvement • Does not provide 24 hour care or supervision • Requires HCP orders and a need for skilled nursing care o Not just patient needs help bathing, ambulation, etc. is not covered by home health care o Skilled nursing care is care provided by someone with a license
home health care
• Homebound--> cannot easily leave home without assistance from at least 1 other person • Provides for Intermittent or acute health care needs o Generally someone gets discharged from hospital and have a wound that needs care for so home health may come to perform wound care for patient
home health care
means health that worsens as a result of being in the health care center **nursing implementation under acute and ambulatory care
iatrogenesis
After planning, you will use nursing _______ which includes: o Modify approach based on the older adult's physical, functional, and mental status o Safety first! o Health Promotion and Disease Prevention Increase participation in health promotion and disease prevention activities Reduce diseases and health-related issues Increase use of services to decrease health hazards (risk for falls) o Nurse's role: Know about available resources Educate and refer them to those services
implementation
Also, with nursing _______ you want to look at acute and ambulatory care avaliable. Identify those at risk for iatrogenesis • Iatrogenesis means health that worsens as a result of being in the health care center o EX: people spending all their time in bed, muscles weaken, and they go home and never get out of bed Early discharge planning Interprofessional teams (not just the nurse!) Standard protocols to screen for at-risk conditions • Falls, UTIs, cognition, skin o Indwelling catheter risk for UTI • Available in hospital Maintain function/prevent functional decline • "the bed is not your friend" • Get them out of bed! The longer in bed, the less likely to recover to previous state. SAFETY! Referral to community-based services
implementation
the drug half-life is ________ in older adults as compared with younger adults o Can led to greater risk for drug toxicity and adverse drug events
increased
Confusion may be a sign of an ________. UTIs are notorious for doing this. A patient will get a UTI and acute delirium and when the ________ is gone, the patient goes back to their fully cognitive function like they were before **atypical symptoms
infection
When normalizing ______ with others manage symptoms and treatments to hide/minimize disability/differences/disfigurement in chronically ill people.
interactions
______ issues include advance directives, estate planning, taxation issues, appeals for denied services (EX: disability), financial decisions, or exploitation by strangers or "trusted others". o Advanced directives are written statements of a person's wishes regarding medical care
legal
(nursing home) o Rapid patient deterioration or function o Caregiver stress and burnout o Alteration in or loss of family support system Transition may be difficult Relocation stress syndrome--> if a patient moves into a long-term care facility, the transition is very difficult for them. They will go into depression, malnutrition, and will have an increased risk of fractures
long-term care facilities
To plan to ______ a crisis: o Treatments and medications they need to take EX: someone with asthma: if they need a treatment, they know they have an inhaler to help o Dietary and lifestyle changes EX: someone with high blood sugar levels; what dietary and lifestyle changes will they need to adapt to? o When to contact the HCP
manage
As a nurse, you play an important role in the _____ of patients with chronic illness. This includes conducting a comprehensive history and physical assessment, participating in interventions and plan of care, teaching the patient and caregiver regarding the treatment plan, implementing strategies for symptom management, and evaluating patient outcomes.
management
• ______ ______ --> HCP, anyone who is in social service sector, it is mandated that we report elder abuse o Mandated to report to elder abuse o In Louisiana, _______ _______ starts at age 60; any person 60 or over that you suspect to be abused or neglected or exploited, you are mandated to report to Adult Protective Services o For younger people, there is no _______ _________ unless they are physically or psychologically okay but their children are stealing from them • Organizational protocols for screening and intervention **elder mistreatment and abuse
mandatory reporting
1. Decreased vision 2. Forgetting to take drugs 3. Use of nonprescription over the counter drugs 4. Use of medications prescribed ot someone else 5. Lack of financial resources to obtain prescribed medication 6. Failure to understand instructions or importance of drug treatment 7. Refusal to take medication because of undesirable side effects These are the causes of ______ _____ by older adults
medication errors
With _______ _____, errors are common. They are common cause of hospitilization and a common cause of disability and death.
medication use
What category of the elderly is from the age of 75-84? **nearly 25% of individuals age 75-84 live in nursing homes
middle-old
Elder _______ and abuse affects 2-10% of community-dwelling older adults. There is a 3x mortality risk of other adults with elderly ______ and abuse. When elderly _____ and abuse is seen, mandatory reporting is required. • Mandatory reporting: HCP, anyone who is in social service sector, it is mandated that we report elder abuse o Mandated to report to elder abuse o In Louisiana, mandatory report starts at age 60; any person 60 or over that you suspect to be abused or neglected or exploited, you are mandated to report to Adult Protective Services o For younger people, there is no mandatory reporting unless they are physically or psychologically okay but their children are stealing from them • Organizational protocols for screening and intervention
mistreatment
Under ____ _____ of a chronic illness/disease, you need to perform a comprehensive health and physical assessment, plan of care, patient and caregiver education, symptom management, and evaluating outcomes of treatments so you can play role in adjusting treatments to achieve the best results. o History: when did this disease start? Has this disease gotten worse or better? Has any treatment helped? Children can begin taking precautions in order to not develop same disease
nursing management
What chronic disease is described below: -affects about 34% of adults -major contributor to other health problems
obesity
What category of the elderly is from the age over 85? *often a widowed, divorced, or single woman dependent on family for support of care *many OA this age outlived children, spouses, or partners, and siblings
old-old
What stage of chronic illness trajectory is described below: -signs and symptoms are present -disease diagnoses
onset (1)
What are the 8 stages of Chronic illness trajectory?
onset, stable, acute, comeback, crisis, unstable, downward, and dying
Some diseases, such as multiple sclerosis, have unpredictable courses that make planning activities difficult. Part of the individual's tasks is to develop a _____ ______ that includes the chronic illness and adjust to the lifestyle changes it necessitates. For example, an individual taking warfarin due to a mechanical heart valve may need to avoid extreme physical sports that have a high potential for injury. ***adjusting to changes in the course of the disease
personal identity
Devices, materials, and equipment that physically prevent individuals from moving freely, such as walking, standing, lying, transferring, and sitting Used ONLY to ensure safety Least restrictive approach Last resort with the care of older adults Determine unmet physiologic or psychosocial needs Highly regulated
physical restraints
After the assessment of an older adult, you will now start _______. This includes: o Identify strengths and abilities Want them to maintain as much independence as possible o Priority goals Gain a sense of control: want them to feel like they have control over care Feel safe Reduce stress as much as possible by telling patient upfront on how the day is going to do, what the plan is, what you will be doing, etc.
planning
• Rx'd and OTCs • Use of multiple medications by a person who has more than one health problem *nursing implementation
polypharmacy
When patients with chronic illnesses have to carry out a _____ _____ _______, the ____ ____ _____: • Vary in degree of difficulty • Impact on lifestyle EX: Someone who has HTN and takes 1 pill a day, that is not a big deal but compare to someone who has DM and has to take 4 shots of insulin and check sugar level 4 times a day; that has more of an effect on their lifestyle
prescribed treatment regimen
o Goal is to help older adults adapt to or recover from disability or an acute functional decline o may occur in an acute Inpatient, long-term care, home o Interprofessional team **nursing implementation
rehabilitation
if a patient moves into a long-term care facility, the transition is very difficult for them. They will go into depression, malnutrition, and will have an increased risk of fractures • A nursing diagnosis that is associated with the disruption, confusion, and challenges that older adults face when moving from one environment to a new environment **long-term care facilites
relocation stress syndrome
With a chronic illness, the patient has to participate in _____ _____ which is when they adjust their schedule to accomodate treatments and limitations.
reordering time
o Increased risk for accidents Most occur in or around the home o Declining thermoregulation higher rate of deaths during severe cold spells and heat waves o Carefully orient older adults on admission Confusion common in a new environment **nursing implementation of older adults
safety
o Assess pattern, duration o Assess quality o Does the person feel "refreshed" after sleep o Sleep hygiene measures **nursing implementation
sleep
When preventing ____ ____ in a chronically ill person: • Ill person withdraws from others • Others withdraw from the ill person • Very important that we remain active with a group of peers but especially with someone with a chronic illness because they tend to believe that those around them don't want to be around them anymore
social isolation
____ ______ may occur with chronic illness because that individual chooses to withdraw from pervious activities or because others withdraw from the chronically ill person. For example: a woman has aphasia secondary to a stroke may be unwilling to go out in public because of embarrassment related to communication issues
social isolation
Administration on Aging (AoA), Area Agency on Aging, Medicare, and Medicaid are all different types of ____ ____ for older adults.
social support
When providing ______ _______ for older adults occurs at 3 levels. First, family members are the primary and preferred providers of ___ ____. Second, a semiformal level of support is found in clubs, religious organizations, neighborhoods, adult day care, and senior citizen centers. Third, older adults may be linked to formal systems of social welfare agencies, health facilities, and government support. Generally, you as a nurse are part of the formal support system.
social support
o Family caregivers (most prevalent means of social support for older patients) o Semiformal Religious organizations, social groups Churches will have people visit elderly people in their homes o Formal In-home professional caregivers Adult day health centers Assisted living centers Nursing homes This falls under the 3 levels of ____ _____ for an older adult.
social support
Chronically ill, cognitively impaired, homeless, and frail are the ___ ____ of older adults.
special populations
What stage of chronic illness trajectory is described below: v -illness course and symptoms controlled by treatment regimen -person maintains everyday activities
stable (2)
For older adults, the _____ of an illness may lead to: o fear and anxiety about health problems and institutions of care o fearful that someone will prescribe a treatment they cannot afford o they may view health care personnel as helpful but perceive institutions as negative and potentially harmful places
stress
What chronic disease is described below: -affects about 7 million adults. 15%-30% disables -leading cause of serious disability -5th leading cause of death
stroke
• Prevent/manage crisis • Prescribed treatment regimen • Control symptoms • Reorder time • Adjust to changes in course of disease • Prevent social isolation • Normalize interactions with others These are _____ of people with chronic illnesses.
tasks
What prevention measure to prevent chronic illness is described below: o Limit disease progression and maintain optimal functioning o Examples: treatment, rehabilitation
tertiary
_____ prevention refers to activities that limit disease progression such as rehabilitation. **chronic illness
tertiary
evidence-based and innovate care coordination and management model A transitional care nurse delivers and coordinates care by nurses and other team members throughout potential and acute episodes of illness Those most likely to benefit from transitional care nursing include those of older adult and those with functional deficits, behavioral or psychiatric issues, multiple chronic conditons, a need for polypharmacy, a recent hospitalization, lack of a support system, low health literacy, and history of nonadherence to treatment **nursing implementation of older adults
transitional care model
What stage of chronic illness trajectory is described below: -unable to keep symptoms or disease course under control -life becomes disrupted while patient works to regain stability -hospitalization not required
unstable (6)
What category of the elderly is from the age of 65-74? **nearly 6% of individuals age 65-74 live in nursing homes
young-old
What are the 4 categories of the elderly?
young-old, middle-old, old-old, and frail old
Ageism is characterized by: a. denial of negative stereotypes regarding aging b. positive attitudes toward the elderly based on age c. negative attitudes toward the elderly based on age d. negative attitudes toward the elderly based on physical disability
C
An important nursing action to help a chronically ill older adult is to a. avoid discussing future lifestyle changes b. ensure the patient that the condition is stable c. treat the patient as a competent manager of the disease d. encourage the patient to "fight" the disease as long as possible
C
What chronic disease is described below: -affects many older adults -3rd leading cause of death
COPD (chronic obstructive pulmonary disease)
Adult ____ care provides social, recreational, and health-related services to individuals in a safe, community-based environment. This includes daily supervision, social activities, opportunities for social interaction, and ADLs assistance for 2 major groups of adults: 1) those who are cognitively impaired and 2) those who have problems independently performing ADLs.
Day
Adult ____ care services are individualized based on need. Programs designed for adults who are cognitively impaired offer therapeutic recreation, support for family, family counseling, and social involvement.
Day
Adult ____ ____ Care centers are similar to adult day care but are designed to meet the needs of older adults and people with disabilities who need a higher level of care. This might include health monitoring, therapeutic activities, one on one ADLs training, and personal services.
Day Health
• Individuals who qualify for both _______ and Medicaid are referred to as dual-eligible. Eligibility and coverage vary by state. For qualified Medicare beneficiaries, __________ pays Medicare premiums, deductibles, and co-insurance as well as long-term care and home health expenses. • In the US, the majority of long-term care is paid for by ________ or private pay
Medicaid
• State-administered, • Needs-based program o eligible low-income people with medical expenses o Program expanded in Louisiana in 2016 (under Affordable Care Act) to include more low-income citizens Medicare or Medicaid?
Medicaid
State employees do NOT PAY SOCIAL SECURITY so they do NOT get _________. they are eligible if they retire from the state they are eligible for the _____ ongoing insurance coverage.
Medicare
_____ does not cover long-term care, custodial ADLs or IADLs care, dental care or dentures, hearing aids, or eyeglasses.
Medicare
• Coverage is limited o Monthly premium for part B Part A is free but only covers hospitalization Part B , you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part B also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic). o Copays for HCP visits, diagnostic tests, etc. o Separate plan for prescription drug coverage
Medicare
• Federally funded insurance for people > 65 o And those < 65 with disabilities or end-stage kidney disease o Funded through Social Security taxes o Only those who pay social security are eligible for Medicare o State employees do not pay social security so they DO NOT get Medicare but they are eligible if they retire from the state they are eligible for the state's ongoing insurance coverage. o People younger than 65 who have disabilities can also be eligible for Medicare
Medicare
• Federally funded insurance for people > 65 o And those < 65 with disabilities or end-stage kidney disease o Funded through Social Security taxes o Only those who pay social security are eligible for Medicare o State employees do not pay social security so they DO NOT get Medicare but they are eligible if they retire from the state they are eligible for the state's ongoing insurance coverage. o People younger than 65 who have disabilities can also be eligible for Medicare • Coverage is limited o Monthly premium for part B Part A is free but only covers hospitalization Part B , you pay a monthly premium, covers physicians visits, diagnostic services like labs and X-rays but doesn't pay for medications. Part B also comes with a copay and deductible (patient has to pay a certain amount up front each year before their insurance kicks in and they have a copay for every time they go for a visit or a diagnostic). o Copays for HCP visits, diagnostic tests, etc. o Separate plan for prescription drug coverage • Out-of-pocket expenditures continue to rise
Medicare
A person who has Medicaid will not have to pay a monthly premium for the long-term portion of the ______ benefit. A person who does not qualify for Medicaid but has Medicare will be charged a monthly premium to cover the long-term care portion. **Programs for All-Inclusive Care for the Elderly
PACE
_______ (Programs for All-Inclusive Care for the Elderly) services include primary care including prescription medications and wound care; physical, occupational, recreational, and speech therapy; adult day care; dental; podiatry; social services; and home health care.
PACE
• Programs for All-Inclusive Care for the Elderly o Care for adults age 55 and older who meet certain financial and health criteria o Allows those who need skilled nursing home level care to stay in community
PACE
Acute or Chronic? o Prolonged (lasts 3 months or more) o Do not resolve spontaneously o Rarely completely cured (but can be managed) o Irreversible pathologic changes (to body systems) o Residual disability (something that impacts the patient's life and ability to function) o Special rehabilitation o Long-term nursing/medical management
chronic
Acute or Chronic? o Rarely completely cured (but can be managed)
chronic
Acute or Chronic? o Residual disability (something that impacts the patient's life and ability to function)
chronic
What special population of older adults is described below: o EX: dementia, delirium, and depression o Trouble with synthesis of new information If you move someone to a nursing home or new home, it is difficult for them to meet and know new people because they have trouble synthesizing the new information o Problem solving EX: they go to the grocery store and they change the layout of the store, someone with cognitive impairment may not know what to do and may leave o Logical thinking
cognitively impaired
The speciality of ______ nursing is: o Complex, skilled, creative care for older patients o Care of older adults based on the specialty body of knowledge of gerontology and nursing o Provide care for older adults using a whole person (physical, psychological, cultural, socioeconomic, functional, developmental) perspective
gerontologic
• Homebound--> cannot easily leave home without assistance from at least 1 other person • Provides for Intermittent or acute health care needs o Generally someone gets discharged from hospital and have a wound that needs care for so home health may come to perform wound care for patient • Caregiver involvement • Does not provide 24 hour care or supervision • Requires HCP orders and a need for skilled nursing care o Not just patient needs help bathing, ambulation, etc. is not covered by home health care o Skilled nursing care is care provided by someone with a license
home health care
What special population of older adults is described below: o person is _______ if they don't have a permanent place to stay such as a shelter, staying with a relative, living on the street, etc. and you would want to contact social services o Increasing numbers o High mortality rate o More health problems that are more difficult to treat o Interprofessional approach
homeless
What form of elder mistreatment and abuse is described below: not providing hygiene or nutritional needs or leaving them alone in house with no interaction Manifestations: Older adult's report of being neglected. Untreated or infected pressure ulcers on sacral area, heels. Loss of body weight. Laboratory values showing dehydration. Poor personal hygiene and lack of adherence with medical treatment. Depression, withdrawn behavior, agitation. Ambivalenet attitude toward caregiver or family member
neglect
The following is characteristics of ___ ____: • The population of the world is aging! o Surviving acute illnesses o Living longer with chronic illnesses o More educated and resourceful o More ethnically diverse
older adults
To _______ a crisis: • Understand the potential for exacerbation/crisis • Adhere to prescribed treatment regimen on a regular basis to prevent that crisis • Know s/s of onset of crisis o May be sudden, or slow/insidious (little minor changes that over time become a crisis)
prevent
When talking about ______ of chronic illness, preventive health behaviors in patient has to be voluntary meaning that the patient undertakes these on own free will. **have primary, secondary, and tertiary interventions
prevention
Chronic illnesses are most often preventable. ______ intervention refers to measures such as a nutritious diet, proper exercise, and immunizations that prevent the occurrence of a specific disease. *Appropriate immunizations for OAs include influenza, pneumococcal, herpes zoster, tetanus/diptheria/pertussis (Td/Tdap), and hepatitis A and B
primary
What prevention measure to prevent chronic illness is described below: o Measures to prevent specific disease o Diet, exercise, lifestyle, immunizations are primary intervention method examples.
primary
What prevention measure to prevent chronic illness is described below: o Early detection of disease o EX: screening o Facilitate interventions to prevent disease progression
secondary
______ prevention refers to actions aimed at early detection of disease that can lead to interventions to prevent disease progression. **chronic illness
secondary
_____-_____ in older adults results when the older adult is: • Unable to meet basic needs and Refuse help o Seen living in standard homes and don't clean their homes like they need to, don't go grocery shopping, etc. • Untreated medical/psychiatric conditions • Live alone o Substandard housing o Often in squalor • Increased mortality
self-neglect
