NS 411 Test 3 (Ch 25, 28)

Secondary Prevention

Focuses on early diagnosis and treatment - Involves screening and detection - Diagnosis and treatment - Planning - Intervening

Tertiary Prevention

Focuses on ongoing follow-up and relapse prevention - Relapse prevention education - Twelve-step programs - Psychotherapy, ex: Cognitive Behavioral Therapy - Pharmacotherapy

Recovery

"A process of change through which an individual achieves abstinence and improved health, wellness, and quality of life" (Center for Substance Abuse Treatment, 2005).

Quote on Ageism

"Ageism is prevalent, and historically older adults have been undeserved when it comes to mental health services."

Patient Protection and Affordable Care Act 2010

- A 50% discount on brand-name and 7% discount on generic drugs for Medicare part D participants in the donuts hole of coverage cap. - Complete disappearance of Part D coverage gap in 2020 - New annual wellness visits, mammograms, and screening visits for cancer and diabetes.

Substance Dependence

- A cluster of cognitive, behavioral, and physiological symptoms indicating that an individual continues to use a substance despite significant substance-related problems. - Impaired control over the use of the substance characterized by drug tolerance to "to stay normal" or prevent withdrawal. - Progressive trajectory

Substance Abuse

- A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences occurring within a 12-month period. - Falls outside of medical necessity or social acceptance - Does not meet criteria for dependence

Core Nursing Interventions continuned

- Abuse Protection: Elder - Active Listening - Activity Therapy - Behavior Management - Bowel Incontinence Care - Caregiver Support - Coping Enhancement - Delirium Management - Dementia Management - Dying Care

Outcome Criteria Rehabilitation/ Recovery

- Acknowledge ATOD and the need for treatment - Identify and implement strategies for managing anxiety without using substances - Develop coping strategies and use them to manage stressors - Rebuild damaged interpersonal and work relationships - Identify positive aspects of self - Develop alternative activities to replace time spent acquiring, using, or recovering from substance abuse

Types of Functional Assessments:

- Activities of Daily Living (ADLs): Basic daily activities of bathing, dressing, toileting, continence, mobility, grooming, and feeding. - Instrumental Activites of Daily Living (IADLs): Basic daily activities needed to live independently in the community - shopping, food preparation, cooking, laundry, managing medications, etc.

Harm Reduction Principles

- Addiction is a disease - Any psychoactive drug can be abused - Accurate information and education can help people make responsible decisions - Persons with ATOD can be helped - Pragmatic approach that initiates treatment at the level which the client is currently using substances and strive for future reduction of harm to self and society

Nicotine Replacement Therapy (NRT)

- Alleviates some of symptoms of nicotine withdrawal like depression.

Bupropion (Zyban)

- Alleviates some of the symptoms of nicotine withdrawal like depression.

Suggested Nursing Diagnoses for Older Population

- Altered Thought Processes - Risk for Violence; Self- Directed - Sleep Pattern Disturbance - Altered Nutrition: Less Than the Body Requires - Relocation Stress Syndrome - Risk for Caregiver Role Strain - Social Isolation - Self-Care/Behavioral Deficit

Commonly Occuring Mental Health Problems in Older Adults:

- Anxiety - Sever cognitive impairment: Like Alzheimer's disease - Mood disorders: Like depression - Suicide - Substance abuse.

Health Care Provider

- Assessment and early identification of risk factors and clues to ATOD problems - Counseling - Intervention and referral activities - Provision of necessary nursing care - Follow-up with clients in treatment or during recovery.

Varenicline (Chantix)

- Blocks nicotine binding - Eases withdrawal by maintaining dopamine levels.

Buprenorphine

- Blocks signs and symptoms of opioid withdrawal; may suppress heroin use.

Risk Factors for Substance Use: The Family

- Child abuse and neglect - Poor parenting skills - Lack of clear behavioral expectations - Lack of monitoring and supervision - Lack of caring - Inconsistent or excessively severe discipline - History of alcohol and other drug abuse - Positive parental attitudes toward alcohol and other drug abuse - Low expectations for children'ts success - Family history of alcoholism and substance abuse.

Principles of Effective Treatment continued...

- Co-existing disorders should be treated in an integrated way - Medical detoxification is only the first stage of treatment - Treatment does not need to be voluntary to be effective - Possible drug use during treatment must be monitored continuously - Treatment programs should assess for HIV/AIDS, Hepatitis B & C, Tuberculosis and other infectious diseases and help clients modify at-risk behaviors - Recovery can be a long-term process and frequently requires multiple episodes of treatment

Challenges and Crises in Older Adults

- Developmental Tasks: Retirement: Role Changes: Income - Adjusting to decreasing physical strength and health - Establishing satisfactory living quarters - Poverty: Higher for minorities, women, persons > 75 years. Reliance on SSI. Heaviest users of health services. - Loss/Isolation: Significant relationships. Health.

Challenges and Crises in Older Adulthood

- Developmental Tasks: Retirement: Role changes: Income. - Adjusting to decreasing physical strength and health - Establishing satisfactory living quarters. - Poverty: Higher for minorities, women, and persons > 75 years. Reliance on Social Security income. Heaviest users of health services. - Losses/ Isolation: Significant relationships, health.

Risk Factors for Substance Use: The Individual

- Early antisocial behavior - Alienation and rebelliousness - Favorable attitudes toward drug use - Susceptibility to peer influence - Friends or siblings who use tobacco, alcohol, and drugs. - Low academic achievement and absence from school - Low self-esteem - Delinquent behavior - Early substance use

Risk Factors for Substance Abuse: The Community

- Economic and social deprivation - Low neighborhood attachment - Community norms that facilitate drug use, abuse, and trafficking - Availability of alcohol and other drugs - Lack of employment opportunities - Extreme wealth - Few opportunities for youth involvement in community - Violence.

Core Nursing Interventions from the National Gerontological Nursing Association

- Emotional Support - Environmental Management: Comfort - *Re-motivation Therapy - Exercise Therapy - Grief Work Facilitation - Patient Rights Protection - *Reminiscence Therapy - Respite Care - Self-Care Assistance - *Psychotherapy

Alzheimer's Disease

- Estimated at least 5.4 million Americans are living with Alzheimer's S- ixth leading cause of death in the US - Payments from all sources for health and long-term care services for persons with Alzheimer's and other dementias will amount to $183 billion - 70% of persons with Alzheimer's live at home, where family and friends provide most of their care

Coordinator/ Collaborator

- Function as member of multidisciplinary team - Initiate programs and encourage involvement by others - Working in collaboration with community leaders to foster comprehensive programs - Participation in programs aimed at strengthening the overall health of the community.

Functional Health

- Functional health can be defined as "the ability to function in the arena of everyday living." - Functional assessment is a comprehensive evaluation of the physical and cognitive abilities required to maintain independence.

Health Care Needs: Nutrition

- General nutrition education should stress adherence to a balanced diet; maintenance of ideal body weight; limited intake of alcohol, fats, and sugars; increased intake of dietary fiber; and avoidance of excessive salt intake. Most older adults are deficient in vitamin D intake, therefore a calcium supplement would be helpful. - Decreases in hearing, vision, and taste may diminish food appeal. When eating out, quiet, well-lit dining areas should be sought to enhance the dining experience. - Decreases in intestinal motility may predispose clients to constipation and overuse of laxatives. - Fluid and fiber should be incorporated into diet. - Thirst sensation may be diminished, so adequate water intake should be encouraged and monitored.

Roles for Nurses

- Health Educator - Health Care Provider - Coordinator/ Collaborator

Health Care for the Elderly

- Home care: Nursing, rehabilitation, personal care - Respite: Temporary, short-term relief - Adult daycare: Out-of-home respite - Community-based living: Senior centers, retirement communities, congregate housing - Life-care (continuous-care) community - Nursing homes: Resources for selections

Nursing Diagnosis related to Substance Abuse

- Ineffective individual coping - Ineffective health maintenance - Ineffective family coping - Powerlessness - Disturbance in self-esteem - Risk for injury - High risk for violence - Spiritual distress

Priority Policy Areas

- Integrated mental health services - Multidisciplinary outreach and wraparound services - Reduce stigma and other barriers to caring for older adults - Increase workforce with training in health care of the older persons - Enhanced caregiver and support - Prevention and health promotion - Enhance research on health and aging

Health Educator

- Keeping up to date on ATOD information - Working with groups, individuals, and families - Educate coworkers, clients, and members of community.

Methadone (Dolophine)

- Keeps client out of illeagl drug culture while counseling is undertaken - A synthetic opiate; blocks craving for and effects of heroin; must be taken daily

Recommendations on Consumption

- Men, no more than two drinks per day - Women, no more than one drink per day - Those 65 years of age or older, no more than one drink per day - Although it was not addressed in the guidelines, children and adolescents up to age 18 or 21 years (depending on state law) should drink no alcohol at all.

Caregivers & Their Health

- More than 34 million unpaid caregivers are providing care to someone age 18 and older who is ill or has a disability - An estimated 9.8 million caregivers provide 8.4 billion hours of care each year to persons with Alzheimer's - Caregiving has negative impacts on health Lowered immunity, elevated blood pressure, musculoskeletal pain are noted physical effects - Depression and emotional pain are noted mental health effects - Half of caregivers who said their health had gotten worse due to caregiving also said the decline in their heath has affected their ability to provide care - Older spousal caregivers had a 63% higher mortality rate than non-caregivers of the same age

Principles of Effective Treatment

- No single treatment is appropriate for all - Treatment needs to be readily available - Effective treatment attends to the multiple needs of the individual - Treatment plans must be assessed and modified continually to meet changing needs - Remaining in treatment for an adequate period of time is critical for treatment effectiveness - Counseling and other behavioral therapies are critical components of effective treatment - Medications are an important element of treatment for many patients

Other Cognitive Assessment:

- Observations and interactions Nurses' Observation Scale Cognitive Abilities (NOSCA) (Person, 2011). - Mental Status Assessment of Older Adults: The Mini-Cog. The Mini-Cog exam is composed of three item recall and the Clock Drawing Test (CDT). Used to detect dementia quickly and easily in various settings, either during routine visits or hospitalization

Impact of Poverty on Older Adults

- On retirement the older adult may experience 40%-60% drop in income. - About 8.9% of older adults live below the poverty line. - Poverty levels are higher for minorities, women, and persons 75 years and older. - 43% of unmarried persons and 22% of married persons over the age of 65 about 90% to 100% of their income comes form social security payments. - Older adults spend about 33% of their income on health care, and since most people on social security, this leads to gaps in healthcare coverage and money on other necessities like housing, food, and etc.

Health Care Needs: Vision & Hearing

- One out of six has visual impairment. - One out of four has hearing impairment - One in five older adults living below the poverty threshold has vision impairment, a rate that is 50% higher than among all other older adults. Medicare does not pay for: - routine teeth cleaning, - routine vision and hearing tests - eyeglass and hearing aid fittings

Suggested Cognitive Assessment Areas

- Orientation: Determine if the client is oriented to time, person, and place. - Memory and retention: Name several items and later ask the client to recall them - Remote memory: Ask about events in life such as childhood or school - Three-stage command: Ask the client to perform three simple acts in succession. - Judgement: Supply a proverb ad ask for an interpretation for example, "The early bird catches the work" or provided a situation and ask the client what to do, for example, "you see a house on fire what would you do?" - Calculation: Provide simple arithmetic problems or ask the client to count backward form 100 or 50 by 5 or 3.

Protective Factors for Substance Use: The Family

- Parent-child attachment - Authoritative parenting style, NOT authoritarian or permissive. - Parental educational expectations - Parental monitoring

Social Security Act

- Passed in 1935, this act provided for a national retirement income system and a system of federal grants to assist states in providing support to aged, disabled, and blind persons and to dependent children. - In 1965 Title 18 of the SS Act was enacted to provide health care coverage for low-income persons, (Medicaid) - Supplemental Security Income is a federally funded program that ensures a minimum monthly income to aged, blind, and disabled persons who are not covered by SS or for whom SS is insufficient.

Older American Act (OAA)

- Passed in 1965; re-authorized in 2016 - Created a system of social services and supports to older adults aged 60 and over. - A network of 56 state units on aging, over 600 area agencies and over 260 tribal organizations.

Multiple Chronic Conditions (MCC)

- Prevalence: 68% of Medicare beneficiaries are being treated for two or more chronic disorders. - Outcomes: As the number of conditions increases, so does the frequency of mortality, poor functional status, hospitalizations, readmission, and adverse drug events. - Cost: 93% of Medicare expenditures are for individuals with MCC.

Planning Consideration

- Provide safe and humane care - Abstinence - Planning must address major medical, social, legal, psychological and vocational needs - Assist the client to recognize use and abuse of substances - Develop a relationship that provides safe and caring support for the client - To know where and how to refer the client and family

Key Services Included in OAA

- Providing information and resources - Homemaker and personal care services - Home delivered and congregate meals - Caregiver support - Preventive health services - Job training - Transportation - Legal assistance - Elder abuse prevention activities

Recovery & Treamtnet

- Recovery begins but does not end with abstinence - Recovery from distorted thinking and values is necessary - Picking up emotional personality development where it left off is necessary - Relationships with others must be re-established - Develop ability to identify individual's "triggers" that set in motion the desire for the drug - Psychotherapy for underlying psychiatric disorders or pain from childhood trauma - Treatment for the client with co-occurring disorders needs to be directed at both the psychiatric disorder and the substance abuse problem

National Survey on Drug Use and Health (NSDUH)

- Reports on the prevalence, patterns, and consequences of drug and alcohol use. - Primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, non-institutionalized population of the United States aged 12 years old or older. - The survey interviews approximately 67,500 persons each year

Protective Factors for Substance Use: The Community

- School anti-drug policies - High neighborhood attachment - Laws and penalties - Employment opportunities for youth - Opportunities for community involvement

Protective Factors for Substance Use: The Individual

- Self-control - Involvement in religious activities - High self-esteem - Conventional peer values - Parental monitoring of peers - Academic confidence - Commitment to school - Attachment to teachers

Disulfiram (Antabuse)

- Taken daily, prevents impulsive drinking - Must avoid hidden sources of alcohol in foods, fumes, and skin preparation.

Fun Facts about the Elderly

- The majority of older adults live independently in the community; 2% live in community housing; only 5% live in nursing homes. - Persons 65 years of age can expect to live for more than 18 additional years. - Two out of three older workers retire before age 65 years. - 42% of women over age 65 are widows, many who live alone. - Older adults consume 30% of all prescription medications and at least 25% of all over-the-counter medications. - Approximately 10% of non-institutionalized older adults receive help with at least one ADL, compared with 891% of institutionalized older adults, who comprise 5% of all Medicare beneficiaries 65 years of age and older. - Informal networks of family, friends, and neighbors provide most health and social services to older adults.

Statistics on Aging Americans

- The number of Americans 65 and older is projected to increase from what was 40.3 million in 2010 to 72.1 million by 2030 - At least 5.6 million to 8 million - nearly one in five - older adults in America have one or more [mental health or substance use] conditions, which present unique challenges for their care.

Profile of the Older Adult

- The older population (65+) numbered 43.1 million in 2012, an increase of 7.6 million or 21% since 2002. - The number of Americans aged 45-64 who will reach 65 over the next two decades - increased by 24% between 2002 and 2012. - About one in every seven, or 13.7%, of the population is an older American. - Persons reaching age 65 have an average life expectancy of an additional 19.2 years (20.4 years for females and 17.8 years for males). - Older women outnumber older men at 24.3 million older women to 18.8 million older men. - The 85+ population is projected to increase from 5.9 million in 2012 to 14.1 million in 2040.

Risk Factors for Suicide in Older Adults

- The recent death of a loved one; - Physical illness, uncontrollable pain or the fear of a prolonged illness; - Perceived poor health; - Social isolation and loneliness; - Major changes in social roles (e.g. retirement).

Older American Act: Title III

- Title III Grants for States and Community Programs Include: Supportive services and Senior Centers: Nutrition services: Caregiver support: Disease Prevention and health promotion - Provided for programs for older adults to established at a state level. The state unit on aging was established to develop a state wide plan for providing services to older adults.

Harm Reduction

- Traditional approach focuses on reducing actual drug use - Harm reduction focuses on moderation of substance use and minimization of its harmful effects.

Myths about Old People

-80% of older persons are healthy enough to engage in normal activities (like sex) - Though reaction times slows with age, older persons are not senile and do not have serious memory deficits. - Older people are not set in their ways, most adapt to such major life events like retirement, having children leave home, and declining health. - Older adults work as effectively as their younger counterparts. - They change jobs less frequently and have fewer job-related accidents, and lower rates of absenteeism. - Most older adults say they feel relatively satisfied most of the time. - Most do not feel a significant restriction on their daily life.

Chapter 25: Substance Use Disorders

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The American Nurse: A Growing Population Article

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Chapter 28: Older Adults in the Community

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Health Care Needs: Social Isolation

37% of people 65 or older live alone. Older women are more likely to live alone than men. Social isolation may be a symptom of a mental health disorder. Depression and dementia are the two most common mental health disorders in older adults. It is estimated that 10-14% of older adults may experience depression and depression increases as functional ability becomes limited. Geriatric depression may develop as a result. Dementia is a serious cognitive impairment involving thought, memory, or personality.

Addiction

A chronic, relapsing brain disease characterized by engaging compulsively in an activity despite negative consequences.

Long-Term Care

A comprehensive range of health, personal, and social services that are coordinated and delivered over a period of time to meet the changing physical, social, and emotional needs of chronically ill and disabled persons.

Living Will

A document that enables a person in advance to make decisions regarding medical care, should the time come when the person is incapable of expressing his or her wishes.

Medication-Assisted Treatment (MAT)

A form of pharmacotherapy; any treatment for a substance use disorder that includes a pharmacologic intervention as part of a comprehensive substance abuse treatment plan.

Life-Care Community

A form of retirement housing that provides comprehensive health and social services to elderly persons. Also known as continuous-care community.

Recovery-Oriented Systems of Care (ROSC)

A framework for recovery from drug addictions, established by the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment.

Congregate Housing

A group housing option for elderly persons in which housing is supplemented by services such as 24-hour security, transportation, recreation, and meals.

Geriatric Evaluation Service (GES)

A program that provides assistance to older adults and functionally disabled adults who are at risk for institutionalization.

Group Homes

A shared living arrangement for a group of older adults who are jointly responsible for food preparation, housekeeping, and recreation.

Aging

A universal human experience that culminates in an end. Aging is not a disease. Aging is the sum total of changes that normally occur with the passage of time. There is not single, simple pattern of aging; it is a natural, life-long and total process that varies within and among individuals.

Durable Power of Attorney

A written document in which one adult gives another adult the right to make health care decisions on the first adult's behalf, in the case of incompetence or inability to render these decisions independently. See also Medical durable power of attorney.

Addiction as a Brain Disease

Abused substances activate the same brain circuits as do behaviors of basic survival such as eating and sex. Repeated drug use increased dopamine. Dopamine is responsible for feelings of pleasure and euphoria. Once this pleasure pathway is activated your brain wants to keep the levels of dopamine high. The abilities to control decision making and judgment and to manage desires and emotion are all negatively impacted. Researchers now believe that the drug-seeking behavior is a primitive response that occurs prior to conscious awareness. The limbic system is the area of the brain that starts the drug-seeking addictive behavior in motion. This knowledge questions the thinking that addiction is related to will power and free choice. Studies show that the brains of heavy chronic drinkers shrink, specifically the frontal lobe, which is responsible of decision making and judgement. p. 636

Dependence

According to DSM-IV-TR dependence can be diagnosed when at least three of the following symptoms have occurred within a 12-month period: - Tolerance to or a marked need for increased amounts of a substance to achieve the desired effect. - Withdrawal symptoms - Unsuccessful attempts to cut down or control use. - Abandonment or reduction of important social, occupational, or recreational activities due to substance use. - Continuation of use despite knowledge or recurrent physical or psychological problems.

Impaired Nurses

According to the American Nurses Association (ANA), nurses who are actively using brain-altering chemicals while treating clients.

Impact of Substance Abuse

Addiction presents a major burden on the health and financial resources of our society. The most recent cost analysis by the Department of Justice's National Drug Intelligence Center (NDIC) included health care, crime, and the associated loss of productivity for dug abuse which were estimated at $193 billion in 2007. Substance use significantly affects not only the user but also his or her immediate and extended family as well as the health ans safety of that person's community. The full impact of substance use is evident when assessing teenage pregnancy rates, HIV/AIDS, sexually transmitted infections (STIs), domestic violence, child abuse, motor vehicle accidents, aggression, crime, homicide, and suicide. 2

Health Care Needs: Mobility

Adults 65 years and older are more likely to experience a fall-related mortality than are younger age groups. Falls are the most frequent injury and cause of hospital admissions for trauma among older adults. Over 90% of hip fractures are caused by falls, in older adults. Also falls account for 40% of the admissions to long-term care facilities. The risk for falling is increased in older adults due to confusion, disturbances in gait, alteration in musculoskeletal functioning, medication side effects, unfamiliarity with new surroundings, poor eyesight, and orthostatic hypotension, which may produce dizziness and syncope. Falls: Increase hospital & nursing home admissions. Arthritis: Affects gait. Osteoporosis. Limited activity: Exercise. Sensory impairment

Primary Prevention for Addction (Policy Changes)

Advocate for increased funding for prevention activities Advocate for changes in policies that promote prevention such as: - establishing smoke-free environments - curtailing advertising on alcohol or tobacco - obtaining reimbursement for prevention activities delivered by health care professionals

Screening for Depression

All primary care providers should screen older adults for depression, as well as conduct a mini-cognitive assessment to determine if there is any mild cognitive decline.

Fetal Alcohol Spectrum Disorders (FASDs)

An umbrella term that includes developmental disorders such as fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorders (ARNDs), and alcohol-related birth defects (ARBDs)

Nurses who abuse substances are most likely to abuse: A. prescription drugs. B. alcohol. C. illicit drugs. D. hallucinogens.

Answer: A Prescription drugs Rationale: Nurses who abuse substances are most likely to abuse prescription drugs. Nurses have easy access to prescription drugs and might use them at higher doses, more often than prescribed, or for nonapproved reasons. Trinkoff and colleagues (1991) reported that alcohol abuse among a large sample of nurses was low, but nurses had higher rates of prescription drug use. Nurses are more likely to abuse prescription drugs rather than illicit drugs. Nurses are more likely to abuse prescription drugs rather than hallucinogens. p. 642

A community health nurse uses tertiary prevention when: A. organizing a 12-step Alcoholics Anonymous (AA) program in the community. B. providing health education programs about substance use. C. screening for alcohol and other drug abuse or addiction. D. targeting at-risk populations.

Answer: A Organizing a 12-step Alcoholics Anonymous (AA) program in the community. Rationale: Organizing a 12-step Alcoholics Anonymous (AA) program in the community is an example of tertiary prevention. It involves ongoing follow-up and treatment to prevent relapses and maintain recovery. Providing health education programs about substance use is an example of primary prevention. Primary prevention involves the identification and modification of risk and protective factors that apply to alcohol and other drug use. Screening for alcohol and other drug abuse or addiction is an example of secondary prevention. Secondary prevention involves early diagnosis and treatment. Targeting at-risk populations is an example of a primary prevention strategy. p. 645

The majority of older persons: A. are healthy enough to engage in normal activities. B. have memory deficits. C. are unable to adapt to change. D. have significant restrictions in their daily lives.

Answer: A Are health enough to engage in normal activities. Rationale: The majority of older persons are healthy enough to engage in normal activities. They do not have serious memory deficits. The majority of older persons are able to adapt to change; most have had to adapt to major life events such as retirement, having children leave home, and declining health. The majority of older persons do not feel any significant restriction in their daily life. p. 702

Increased recovery from all addictions is due to (select all that apply): A. positive social support. B. residence in a family setting. C. adequate socioeconomic resources. D. absence of family history of abuse. E. increased age. F. male gender.

Answer: A, B, C, D, positive social support, residence in a family setting, adequate socioeconomic resources, absence of family history of abuse. Rationale: Positive social support, residence in a family setting, adequate socioeconomic resources, and absence of a family history of alcoholism and drug abuse have also been associated with better chances of increased recovery from all addictions. Age and gender do not predict recovery.

A community health nurse will be teaching about common health needs of older adults at a local senior center. Which information should be included in the presentation (select all that apply)? A. Older adults should increase their intake of fluids. B. Older adults frequently experience chronic health conditions. C. Older adults are at a higher risk for adverse drug reactions. D. Older adults are more likely to experience fall-related mortality than younger age groups. E. Older adults may be noncompliant with medications owing to lack of finances. F. Older adults never abuse drugs because they are aware of the negative consequences.

Answer: A, B, C, D, E Rationale: Older adults should be encouraged to drink adequate amounts of water because their sense of thirst may be diminished as well as the fact that intestinal motility decreases with age. Four of five older adults experience at least one chronic health condition, and many suffer from multiple chronic diseases. Older adults are at a higher risk for adverse drug reactions because of normal aging changes, conditions that affect the body's response to drugs, and the use of multiple drug regimens to treat concurrent health problems. Older adults are more likely to experience fall-related mortality than are younger age groups. Deaths related to falls increase with age. Older adults may not be compliant with medication regimens because of lack of finances or access to pharmacy services. In addition to medication misuse because of lack of knowledge or physical or cognitive impairment, the older adult client may abuse drugs in an attempt to cope with depression and loss. p. 718

A community health nurse calls multiple community contacts to identify an adult daycare center that a client with Alzheimer disease can attend and then makes all the arrangements for the client to participate in this program, including meeting with the client's family to educate them about why this is a good choice for the client. This is an example of the nurse performing the roles of (select all that apply): A. advocate. B. case manager. C. facilitator;collaborator. D. teacher. E. mentor. F. conductor.

Answer: A, B, D Advocate, Case manager, Teacher Rationale: In the advocate role, the nurse must be sensitive to the needs of the client and family, have a broad knowledge base of available community resources and supports, and be able to communicate a professional assessment of client and family needs to the appropriate service providers. The advocate role is used in the example in that the nurse is locating a needed service for the family in the community. As a case manager, the nurse refers the client and family to appropriate resources and monitors and coordinates the extent and adequacy of services to meet family health care needs. As the nurse contacts the adult daycare center and then makes all the arrangements for client attendance, the case manager role is being performed. As a teacher, the nurse teaches about health promotion, chronic conditions, and the aging process. In the facilitator-collaborator role, the nurse works with others to meet a common goal. This may happen on a broader scale when working with state government representatives or at the local level when working with coalitions. Conductor and mentor are not roles assigned to community health nurses. p. 718-720

Children diagnosed with fetal alcohol syndrome (FAS) (select all that apply): A. will experience small gestational age. B. will display symptoms immediately after birth. C. will experience failure to thrive. D. will experience abnormalities in the central nervous system. E. will experience smaller-than-normal brain size. F. will experience learning disabilities.

Answer: A, C, D, E, F Will experience small gestational age, will experience failure to thrive, will experience abnormalities in the CNS, will experience small-than-normal brain size, will experience learning disabilities.

An example of a central nervous system depressant is: A. nicotine. B. alcohol. C. marijuana. D. LSD.

Answer: B Alcohol Rationale: Alcohol is an example of a central nervous system depressant. Nicotine is considered to be a central nervous system stimulant. Marijuana is an example of a central nervous system stimulant. LSD is an example of a hallucinogen. p. 636

When considering family dysfunction related to substance abuse and dependence, the role of the enabler is to: A. blame an individual as the sole source of the family's problem. B. limit or eliminate the harmful consequences of the user's behavior. C. become overly close to one special child. D. compensate for the irresponsible behaviors exhibited by the user.

Answer: B Limit or eliminate the harmful consequences of the user's behavior. Rationale: Limiting or eliminating the harmful consequences of the user's behavior is the role of the enabler. The abuser is enabled to continue the abuse pattern because he/she does not have to face the problems brought on by their behavior. Blaming an individual as the sole source of the family's problem is known as scapegoating. Becoming overly close to a special child is known as "triangle in." Compensating for the irresponsible behaviors exhibited by the user is the overfunctioner's role. p. 643-644

Which program provides payment for long-term care of impoverished older adults in nursing homes? A. Medicare B. Medicaid C. Private insurance D. "Medigap" policies

Answer: B Medicaid Rationale: Medicaid pays for most nursing home stays for older adults with limited assets and financial resources. Medicare pays only a small amount of nursing home costs directly related to skilled nursing and rehabilitative services. The majority of private insurance programs do not have long-term care services as a standard in their program. "Medigap" policies traditionally help cover the expenses that Medicare does not cover, such as co-payments, deductibles, and services that are over the allowable limit of cost for Medicare. They do not pay for long-term care in nursing homes. p. 714-715

Which statement about victimization of older adults is true? A. Self-neglect occurs when family members do not assist with completing ADLs. B. Older adults rarely report acts of abuse. C. Financial abuse is easy to detect. D. Older adults are more likely to be abused by a stranger than a family member.

Answer: B Older adults rarely report acts of abuse Rationale: Older adults rarely report acts of abuse. This may be due to physical or mental impairment; fear of injury, retaliation, or abandonment; or fear of not being believed or taken seriously. Self-neglect occurs when older adults neglect themselves and their living space. Financial abuse is usually difficult to detect. Older adults are at risk from abuse and neglect from family members and other caregivers. Families experiencing the stress of caring for a chronically ill member are at high risk for elder abuse or neglect. p. 708-709

The provision of temporary, short-term relief to family caregivers is called: A. long-term care. B. respite care. C. home care. D. foster care.

Answer: B Respite care Rationale: Respite care refers to provision of temporary, short-term relief to family caregivers. Trained personnel care for the older adult client while the caregiver is away for a period of hours, days, or even weeks. Long-term care refers to a comprehensive range of health, personal, and social services that are coordinated and delivered over a period of time to meet the changing physical, social, and emotional needs of chronically ill and disabled persons. Home care refers to a range of health and supportive services provided in the home to persons who need assistance in meeting health care needs. Foster care refers to a community-based support system in which the older adult client is cared for in a personal residence by a family licensed through a social services agency to provide meals, housekeeping, and personal care services. p. 706

Which stage of addiction is a client in when alcohol and drugs are used on a daily basis to avoid pain and depression? A. First stage B. Second stage C. Third stage D. Fourth stage

Answer: B Second Stage Rationale: The second stage in the process of addiction is dependency. Alcohol and drug use is daily or continuous and is done to avoid pain and depression. Use is out of control, as the addict attempts to feel normal. The first stage in the process of addiction involves experimental and social use. The second stage in the process of addiction is when the abuse happens. Alcohol and drugs are used regularly. Use may occur during the day and while alone rather than with others. There is not a third or fourth stage in the process of addiction. p. 635

Which statement about the incidence and prevalence of substance abuse is correct? A. The highest incidence of dependence and abuse is among those younger than 18 years of age. B. There are no significant differences in the incidence of drug abuse and dependence in black and white populations. C. Illicit drug use is highest among the black population. D. More substance dependence is found in those with higher socioeconomic levels.

Answer: B There are no significant differences in the incidence of drug abuse and dependence in black and white populations. Rationale: There are no significant differences in drug abuse and dependence in black and white populations. Rates for blacks are 9.6%; rates for whites are 8.8%. The highest dependence and abuse is among the young, especially those 18 to 20 years of age. Illicit drug use is highest among American Indians or Alaska Natives (18.3%), followed by blacks (9.6%). More substance dependence is found in those at poorer socioeconomic levels. p. 640-641

According to Erikson, which developmental task do older adults experience? A. Intimacy versus isolation B. Generativity versus stagnation C. Integrity versus despair D. Identity versus role confusion

Answer: C Integrity versus despair Rationale: Integrity versus despair is the developmental stage experienced by older adults. Intimacy versus isolation is the developmental stage experienced by young adults. Generativity versus stagnation is the developmental stage experienced by middle-aged adults. Identity versus role confusion is the developmental stage experienced by adolescents. p. 703

Which act is responsible for establishing the Medicare program? A. Omnibus Reconciliation Act 1981 B. Older Americans Act C. Social Security Act D. Balanced Budget Act 1997

Answer: C Social Security Act Rationale: The Social Security Act established the Medicare program, a federal program providing hospital and medical insurance to persons entitled to social security. The Omnibus Reconciliation Act 1981 shortened acute inpatient hospital stays in the Medicare program. The Older Americans Act developed Congressional policies related to aging, defined responsibilities of state and local governments, and provided for demonstration projects, research, and training programs. The Balanced Budget Act 1997 stated that Medicare recipients and their physicians may privately contract to pay for services, even if those services are qualified reimbursable by Medicare. p. 714

A cluster of cognitive, behavioral, and physiological symptoms that indicate that an individual continues to use a substance despite significant substance-related problems is called: A. substance use disorder. B. substance abuse. C. substance dependence. D. addiction.

Answer: C Substance Dependence. Rationale: Substance dependence refers to a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues to use a substance despite significant substance-related problems. Unlike substance abuse, substance dependence also includes tolerance, withdrawal, and a pattern of compulsive use. Substance use disorder is an overarching term, encompassing both substance abuse and substance dependence. Substance abuse refers to a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences occurring within a 12-month period. Addiction focuses on genetic, psychosocial and environmental influences in the development of substance use, abuse, and dependence. p. 634

A community health nurse is referring one of her clients to an Alcoholics Anonymous (AA) program in the community. This would be an example of using: A. professional resources. B. federal resources. C. community resources. D. pharmacotherapeutic resources.

Answer: C Community resources Rationale: Community resources include self-help and other support groups such as Alcoholics Anonymous (AA). It is important that the nurse be familiar with these resources in the community. The nurse is in a better position to refer clients to these groups if the nurse has attended some group meetings and gained first-hand experience and knowledge. One source of professional resources for the community health nurse is the International Nurses Society on Addictions, a professional organization of nurses who work with addicted clients in varied settings. Federal resources include publications that are provided for free by the federal government as well as low-cost subscriptions for materials that summarize research findings and provide guidance for developing alcohol and drug treatment and prevention programs. Pharmacotherapeutic resources would be medications that are available to help those who are addicted. p.651

Which type of community-based living arrangement provides comprehensive health and social services to the older adult? A. Retirement communities B. Congregate housing C. Group homes D. Continuous-care communities

Answer: D Continuous-care communities Rationale: Continuous-care or life-care communities are a form of retirement housing that provides comprehensive health and social services to older adults. Residents move from one level to others within the community as their health care needs change. Retirement communities are residential developments designed for older people who may own or rent the units. Recreational and some support services are available. In most, residents must contract for health care services on their own. Congregate housing describes a variety of group housing options for the older adult in which housing is supplemented by services such as 24-hour security, transportation, recreation, and meals. Group homes provide shared living arrangements for a group of older adults who are jointly responsible for food preparation, housekeeping, and recreation. p.706-707

Medicare provides: A. comprehensive health insurance for older adults. B. health insurance to only poor older adults. C. payment for older adults to receive preventive care. D. limited coverage for health care services for older adults.

Answer: D Limited coverage for health care services for older adults. Rationale: Medicare provides limited coverage for health care services for older adults. Medicare does not provide comprehensive health insurance for older adults. It does not cover costs and services, such as deductibles, co-insurance premiums, additional charges when Medicare rates are not accepted as full payment, and charges for long-term care, dental care, eyeglasses, hearing aids, and preventive care. Medicaid provides care for the poor older adult population. However, some states set Medicaid eligibility requirements below the federal poverty line, so many older adult poor do not qualify for Medicaid. Medicare does not provide payment for preventive care. Preventive care services must be paid for out of pocket by the older adult or covered by a "Medigap" policy. p. 713

Brief Intervention

Are those practices that aim to investigate a potential problem and motivate an individual to do something about his substance abuse, either by natural, client-directed means or by seeking additional substance ab use treatment. Time-limited counseling strategy to reduce substance use in non-dependent users whose consumption patterns put them at risk for problems associated with substance use Goal: - Increase awareness and insight to use - To stabilize and moderate use.

Biophysical Model of Addiction

As described by Mosher, the host is the person who has the addiction; the agent is the alcohol or other drug sufficient in quantity to cause harm to the host; and the environment includes the social, economic, physical, political, and cultural settings in which the host and agent interact. The environment also includes the meanings, values, and norms assigned to a drug by its culture, community, and society. It is true that alcohol and other drugs addictions could not exist if the alcohol or illicit drugs were not available. Therefore, the role of addicting drugs and alcohol is that the agent in the public health model. The addiction doe snot occur solely because of the agent. Some host and environmental factors also contribute to the development of addiction. p. 634

Older American Act: Title VII

Authorizes protection of vulnerable older adults Long-term care ombudsman - Advocate for residents in nursing homes and assisted living facilities - Educate consumers on finding quality LTC

Abstinence

Avoidance of a substance that can cause dependency or addiction.

Gateway Theory of Drug Use

Basically adolescents begin experimenting with alcohol or tobacco, sometimes later progressing to marijuana. In a small percentage of cases, they move on to other types of drugs as they get older. The initial lure may be curiosity, peer pressure, stressor, or simply mimicking adult behaviors p. 635

Recovery-Oriented Systems of Care

By definition, both health and recovery depend on individuals experiencing wellness or well-being in addition to the absence of disease or infirmity.

SAMHSA

Center for Mental Health Services (CMHS) - Focuses on prevention and treatment of mental disorders Center for Substance Abuse Prevention (CSAP) -Seeks to prevent and reduce the abuse of illegal drugs, alcohol and tobacco Center for Substance Abuse Treatment (CSAT) - Supports the provision of effective substance abuse treatment and recovery services Office of Applied Studies (OAS) - Primary responsibility to collect, analyze and disseminate behavioral health data

Health Issues of Older Adults

Chronic disease management Medication management Vision & hearing Nutrition and dental care Mobility Functional health Victimization and abuse Mental health

Multipurpose Senior Centers

Community centers that provide lunch programs, home-delivered or congregate meals, socialization, recreational activities, health counseling and screening, information and referral services, and legal and financial counseling services to elderly persons and their families.

SBIRT (Screening, Brief Intervention, and Referral to Treatment)

Comprehensive, integrated public health approach to delivery of early intervention and treatment services for those at risk and those with substance use disorders

Recovery from Mental Disorders and Substance Use Disorders

Definition: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Four major dimensions that support a life in recovery: - Health: overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way; - Home: a stable and safe place to live; - Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and - Community: relationships and social networks that provide support, friendship, love, and hope.

Hallucinogens LSD, PCP, STP, DOM, mescaline, psilocyblin, or MDMA and MDA (Ecstasy)

Desired Effects: Altered perceptions, heightened awareness, sense of spiritual insight, increased sexual pleasure. Health Consequences: Violence and self-inflicted injuries, memory loss and illusions, speech difficulty, convulsions, coma, ruptured blood vessels in the brain, cardiac and respiratory failure, psychotic episodes, flashbacks.

Hallucinogens: Cannabis, hashish, THC

Desired Effects: Compliance with social custom, sense of well-being, relaxation, altered perceptions, euphoria, increased appetite, relief of nausea and vomiting, heightened sensory awareness, enhanced sociability. Health Consequences: Marijuana: dry mouth, sore throat, increased heart rate, orthostatic hypotension, bronchitis, immunosupression, reduction in testosterone and sperm count, disruption of menstrual periods and ovulation, anxiety and extreme self-consciousness, paranoia and panic, impaired judgment, decreased REM sleep, impaired ability to carry out goal-directed tasks, apathy, social withdrawal, decreased concentration, hallucinations, and delusions.

Inhalants: Acetone, benzene, amyl and butyl nitrate, nitrous oxide, gasoline, toluene.

Desired Effects: Disorientation, increased euphoria. Health consequences: Mouth ulcers, gastrointestinal problems, anorexia, confusion, headache, ataxia, convulsions, death form asphyxiation, permanent brain damage, memory interference, damage to airways, lungs, kidneys, and liver, and nose bleeds.

CNS Stimulants: Cocaine, amphetamines, Ecstasy, MDMA

Desired Effects: Elevated mood, enhanced sexual stimulation, euphoria, relief of fatigue, increase in alertness, loss of appetite. Health consequences: Hypertension, increased alertness, local anesthesia, cerebral vascular accident, paranoia, hallucinations, seizures, death, toxic effects to fetus, increased heart and respiratory rates, irregular heartbeat, physical collapse, high fever, cardiovascular accident and cardiac arrest, psychosis.

CNS Depressants: Narcotics (morphine sulfate, Percodan, Dilaudid, Damerol, Dolophine, Darvon, Talwin, Stadol, heroin, codeine)

Desired Effects: Euphoria, a thrill similar to orgasm, diminished response to pain, drowsiness, decreased anxiety, and fear Health Consequences: Respiratory failure, coma, death, trauma, and accidents during drug-seeking behavior; increased risk for HIV and hepatitis, and localized and systemic infections; convulsions associated with withdrawal.

Anabolic Steroids

Desired Effects: Maintenance of or improvement of athletic performance, increased muscle size and strength, increased aggressiveness. Health Consequences: Liver damage and liver cancer, endocrine abnormalities (e.g, decreased plasma testosterone, decreased luteinzing hormone, atrophy of testes,) decreased libido, acne, water and salt retention, stunting of bone growth in children, impotence, mood swings with paranoia, violent behavior.

CNS Stimulants: Caffeine (coffee, tea, cola, other soft drinks, chocolate)

Desired Effects: Relaxation, compliance with social custom, increased wakefulness, increased alertness, diminished sense of fatigue, blocked drowsiness, facilitated mental activity. Health Consequences: Muscle twitching, rambling thoughts and speech, heart arrhythmias, motor agitation, ringing in the ears, flashes of light, stomach complaints, breasts cysts, spontaneous fetal loss.

CNS Stimulants: Nicotine (cigarettes, snuff, chewing tobacco, pipes, cigars)

Desired Effects: Relaxation, relief form compliance with social custom, appetite control, increase in energy. Health Consequences: Increased illness and absence from work, chronic obstructive pulmonary diseases (emphysema and bronchitits associated with shortness of breath, cough, excessive phlegm), coronary heart disease, cancers of the mouth and lungs, interaction of tobacco smoke with medications leading to decreased effectiveness of medications.

CNS Depressants: Alcohol, barbiurates, benzodiazepines, nonbarbiturates

Desired effects: Relaxation, euphoria, disinhibition, sedation, compliance with social custom, decreased tension and anxiety, decreased inhibition, mental relaxation. Health Consequences: Death from overdose, alone or in combination with CNS depressants; illnesses resulting from damage caused by chronic exposure of tissues in every organ and system of the body due to toxic effects; irreversible brain damage and resultant cognitive difficulties, fetal alcohol spectrum disorders, trauma and accidents, respiratory depression, seizures, coma, death.

Implementation

Engage in treatment - Substance-abuse intervention Detoxification - Safely and comfortably - Enhance motivation Access treatment program - Inpatient treatment - Outpatient treatment - Day treatment - Medication Assisted Treatment

12 Step Program Fundamentals

Fundamental concepts - Powerless over the addiciton and lives are unmanageable - Are not responsible for diesease but for their recovery - Can no longer assign blame to others

Epidemiology

In 2013 an estimated 24.6 million persons (8.2 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

CAGE Questionnaire

In the last 3 months: - have you ever felt you should CUT down on your drinking? - has anyone ANNOYED you or gotten on you nerves by telling you to cut down or stop drinking? - Have you ever felt bad or GUILTY or bad about how much you drink? - Have you been waking up wanting to have an alcoholic drink (or EYE-OPENER)?

Tertiary Prevention of Addiction

Include twelve step programs like alcoholics anonymous. AA is a self-help program with a spiritual base. Others include self-help groups and programs for spouses and co-dependents. Also medication-assisted treatment (MAT) is a form of pharmacotherapy and refers to any treatment for an substance use disorder that includes pharmacological intervention as part of a comprehensive substance abuse treatment plan. The ultimate goal of the plan is patient recovery with full social function.

Other Drugs: (Date Rape Drug)

Includes flunitrazepam (Rohypnol); produces rapid dis-inhibition and relaxation, as well as amnesia; ETOH potentiates the effects.

Health Care needs: Incontinence

Incontinence is a significant cause of disability and dependency in the older adult population. Incontinence is the leads cause of institutionalization of persons older than age 65. Incontinence may contribute to social isolation through embarrassment, feelings of loss of control, low self-esteem, and infantiliazaiton. Incontinence increases with age.

Continuing Education

It's critical that academic and continuing education curriculums go beyond the three Ds — dementia, delirium and depression - and address conditions, such as substance abuse and psychosis.

Office of National Drug Control Policy

Mission: to establish policies, priorities, and objectives for the Nation's drug control program goals to reduce: - illicit drug use - manufacturing, and trafficking - drug-related crime and violence - drug-related health consequences

Primary Prevention of Addiciton

METHODS: Education and Information, Personal Development, Alternatives, Norms and Standards and Community Mobilization. INDIVIDUAL: Posters, Skill building, after-school programs, alcohol, tobacco, and other drug use principles, beliefs, and behaviors. Clean up Projects. FAMILY: Programs. Parenting Training, Family Night, Health care coverage for treatment, family support.. PEERS: Seminars, Work teams, Mentors, Peer support programs, Alcohol-free events. SCHOOL/WORK: Teacher and supervisor training, supportive environment, company teams, SAP/EAP, Coalition building COMMUNITY: Brochure distribution, Wellness programs, Park facilities, Money to agencies, Media campaign.

Geriatric Depression

May develop as a result of actual or perceived losses, environmental stresses, neurological or endocrine disorders, adverse effects of medication, infection, or alcohol consumption. Treatment of depression in older adults may be delayed or never pursed because sadness and loss are often thought to be normal consequences of aging. Affects 7 million adults 65 years and older. Often goes unrecognized and untreated in the older adult population. Complicates chronic conditions such as heart disease, diabetes, stroke. Depression is linked to higher health care cots and higher mortality from suicide and cardiac disease. Responds to effective treatment. Also presents a serious public health problem when left untreated.

Substance Abuse and Mental Health Services Administration (SAMHSA)

Mission: Reduce the impact of substance abuse and mental illness on communities in the US

NIDA

National Institute on Drug Abuse: Mission is to use the power of science to understand addiction and abuse by funding research on the prevention, etiology and treatment of drug abuse and addiction

Elder Abuse and Neglect

Older adults are at risk for abuse and neglect from family members and other cargivers. Financial abuse is a common problem, but it is hard to detect. Self-neglect is one of the most common forms of elder abuse. Social isolation places older adults, especially those who are depressed and live along, at risk for neglecting themselves and their living space.

Health Care Needs: Medication Use

Older adults consume approximately 34% of all prescription medication. Prescription drug cost keep on increasing, which is a hardship for most older adults. Older clients are also at a higher risk for adverse drug reactions, these are the reasons why. - Normal aging changes that affect the absorption, distribution, metabolism, and excretion of drugs in the body - Conditions, such as bed rest, dehydration, congestive heart failure, and stress that affect the body's response to drugs. - The use of multiple drug regimens to treat concurrent health problems.

Staticstics on Aging Population & Nursing

Only about 1 percent of RNs and only 3 percent of advanced practice registered nurses (APRNs) are certified in geriatric nursing. Those who have expertise in both geriatric and psychiatric mental health nursing are even more rare.

Overdose

The exhibition of symptoms that indicate an individual has ingested a level of a drug, or combination of drugs, that exceeds the person's individual tolerance.

Substance Use Disorders

Physical states that encompass both substance abuse and substance dependence. This is an overarching term used in the Diagnostic and Statistical Manual of Mental Disorders.

Medical Daycare

Programs closely affiliated with hospitals or nursing homes that are aimed at providing comprehensive rehabilitation and support services, frequently to elderly clients discharged from the hospital.

Social Daycare

Programs designed to meet the needs of chronically disabled clients and to provide an opportunity for socialization, recreation, monitoring, and other social services.

Drug Abuse Warning Network (DAWN)

Public health surveillance system that monitors: - Drug-related visits to EDs in selected metropolitan areas - Drug-related deaths investigated by medical examiners and coroners Helps communities identify emerging problems, improve patient care, and manage resources

Screening for Depression

Purpose: Identify condition in clients who do not report symptoms Conduct in appropriate setting and with age appropriate tools: - Geriatric Depression Scale (GDS) - Center for Epidemiologic Studies - Depression Scale (CESD) - Patient Health Questionnaire (PHQ)

Brief Interventions

Those practices that aim to investigate a potential problem and motivate an individual to do something about his substance abuse, either by natural, client-directed means or by seeking additional substance abuse treatment" (Substance Abuse and Mental Health Services Administration, 1999).

Retirement Communities

Residential developments designed for older people, who may own or rent the units. Recreational and some support services are available. In most retirement communities, residents must contract for health care services on their own.

Medication Management

Risk of adverse drug reactions caused by: - Normal aging - Health conditions - Multiple drugs Nonadherence to prescribed drugs - Lack of finances - Lack of knowledge - Complexity of regimen

Comorbidity

Same as co-occuring disorders. When there is more than 1 medical disorder going on in a person.

Secondary Prevention of Addiction

Screening and Detection: Nurses should screen for alcohol consumption in any setting in which women of reproductive age are treated or when prenatal care is provided. Various Biological tests as well as written questionnaires are available for use in screening. CAGE-AID are appropriate when detecting late-stage chronic use. The AUDIT-C is an effective brief screening three-question tool for alcohol use in early stages of risk or dependence in adults. The geriatric version MAST-G is appropriate for use with seniors. POSIT is effective for adolescents.

FDA Approved Drugs to Treat Addiction

Thse drugs have been demonstrated to be effective in the treatment of alcohol - Disulfiram - Naltrexone - Acamprosate These drugs have been demonstrated to be effective in the treatment in opioid dependence. - Methadone - Naltrexone - Buprenorphine

Person First Language

Terminology that reflects nonjudgmental and culturally sensitive responses that enhance communication in therapeutic alliances.

Office of National Drug Control Policy continued..

The Administration's plan for reducing drug use and availability is based around four major policy areas: - Substance Abuse Prevention - Substance Abuse Treatment - Domestic Law Enforcement - Interdiction and International Counterdrug Support

The Old-Old

The Old-Old have been defined as persons 85 years and older.

Tolerance

The capacity to ingest more of a substance than other people can without showing impairment of function.

Foster Care

The care of a child or an elderly client in a personal residence by a family licensed through a social service agency to provide meals, housekeeping, and personal care services.

Co-Occurring Disorders

The coexistence of more than one medical disorder in an individual; for example, the exhibition of both psychiatric disorders and substance use disorders in an individual. Also known as comorbidity.

Twelve-Step Programs Extended

The first recovery program was the 12-step Alcoholics Anonymous (AA) program. The AA philosophy and inspirational stories of personal recovery are found in the big book. AA is a self-help program with a spiritual base. AA provides fellowship, social support, constructive suggestiions, methods that have proved effective, sponsorship of a new member by an older member, and suggested program of hope for recovering alcoholics. Participation is strictly voluntary, and the only requirement for membership is a desire to stop drinking.

Common Chronic Conditions Seen in Older Adults

The likelihood of disability increases with age. Disability rates rose with age for both males and females. - Arthritis - Cancer - Cataracts - Diabetes - Hearing loss - Heart Disease - Hypertension - Osteoporosis/hip fractures - Stroke - Varicose veins

Withdrawal

The physical, psychological, and behavioral symptoms that result as a person who has engaged in long-term heavy substance abuse reduces or stops the use of the substance.

Case Management

The process by which services are organized and coordinated to meet client needs.

Home Care

The provision of health and supportive services in the home to persons who need assistance in meeting their health care needs. Also known as home health care.

Respite Care

The provision of temporary, short-term relief to family caregivers.

Co-Dependence

The relationship between a substance abuser and one or more persons (usually a family member) who attempt to assist and control the abuser's behavior through empathy and encouragement.

Gerontology

The study of aging persons and the process of aging.

The Young-Old

The young-old are persons between the ages 65-74

Omnibus Reconciliation Act 1987

This act aimed to improve the standards of nursing home care, expand coverage by registered and licensed practical nurses in nursing homes, and require formal training, in-service education, and competency-based evaluation of nurse's aides working in nursing homes. Standards were to be implemented by 1990.

Omnibus Reconciliation Act 1981

This act shortened acute inpatient hospital stays in the Medicare program. It forced patients out of acute care institutions and into community-based institutional care, long-term care, and other community-based supportive services. Most of the patients affected were older adults.

Detoxification

Treatment for withdrawal from alcohol and other drugs that is necessary for some substance-dependent individuals.

Screening

Used to identify who is at risk Different screening tools; consider - Target population, e.g. age - Language spoken - Time available for administering - Staff or client administered

Naltrexone:

Used to reduce craving; blocks euphoric effects of opioid for up to 72 hours