Test 1-Older Adult
Functional age
-relates to "what I can do" -varies with each individual -is a better way of determining when we are "old"
Geriatric syndromes
Include: -pain -falls -polypharmacy -incontinence -pressure ulcers -cognitive impairment/delirium
Baby boomers
-1946 to 1964 -this generation is coming -important bc by 2030 predicted that 1 out of 5 ppl will be over the age of 65 & 1 out of 8 will be <85 -in the future almost all nurses will be involved in the care of the older adult in some way
Prevention
-In nursing its important to know the difference b/w normal aging & pathology and illness -also need to be aware of which pts are at risk for developing functional complications -______ = key in this population!
Young-old
-OA chronological and psychological category = 65 - 74 YOA
Middle-old
-OA chronological and psychological category = 75 - 85 YOA
Old-old
-OA chronological and psychological category = 85 + -often considered frail
Yesavag Geriatric Depression Scale
-Screening tools for depression -a simple tool that doesn't require clinical experience to administer
1. Amnesia 2. Aphasia 3. Apraxia 4. Agnosia 5. Abulia
-While the course of the types may be different, the cardinal signs of dementia are the same and have a profound impact on the person's quality of life: -the foremost cardinal sign is memory impairment (__1__), followed by one or more of the following: +__2__: impaired language +__3__: inability to perform complex motor activities +__4__: failure to recognize or use familiar objects or utensils +__5__: disturbances in executing functions such as planning, organizing, sequencing, abstracting, or problem solving
1. Gerontology 2. Geriatrics
-__1__; what nursing has adopted for a broader prospective of normal aging; has become a specialty of nursing -__2__; usually a specialty of medicine; focuses on disease
Importance of *language* 1. geriatric 2. gerontologic
-_____ we use when talking w/, or about OAs reflects our attitudes -using patronizing/demeaning terminology is disrespectful; can influence others we work w/ to do the same -this is why what was once referred to as "__1__" nursing is now "__2__" nursing
Delirium
-a geriatric emergency =acute confusion that is a transient and nonspecific organic mental syndrome -characterized by: a reduced ability to focus, sustain, or shift attention -there may also be a disturbance of consciousness or cognition such as: memory loss, disorientation &/or language disturbances
Alzheimer's disease
-a progressive neurodegenerative disorder that generally erodes cognitive function and eventually causes death -most common form of dementia
Confusion Assessment Method
-a user friendly tool for screening pts for delirium -doing this assessment once on admission is not enough -it should be repeated periodically to look for changes
Delirium
-abrupt change in mental status or confusion -one of the cardinal signs of impending illness in OAs -is a reversible condition, you just have to identify the cause!
Depression
-affect: flat -onset: can't be recent, usually related to some life change or event -course over 24 hrs: stable but tends to be worse in the morning -consciousness: usually not affected -alertness: normal -psychomotor activity: may be agitated or inactive -duration: may be chronic -attention: will show little impairment -orientation: usually oriented -speech: may speak slowly
Dementia
-affect: not flat -onset: is insidious, growing slowly over the yrs -course over 24 hrs: is stable but changes with stress -duration: years -attention: will have trouble paying attention -orientation: impaired -speech: may simply have trouble finding words
Delirium
-affect: not flat -onset: sudden or abrupt -course over 24 hrs: fluctuates and is worse at night -duration: may last hrs - wks -attention: will have trouble paying attention -orientation: impaired -speech: may be slow, rapid or incoherent
*Trigger* behaviors (delirium)
-agitation or lethargy -fluctuation in / altered LOC -memory impairment or disorganized thinking -wandering -uncooperativeness or failure to follow instructions (more subtle ____) -changes in behavior or function; subtle changes in behavior or the ability to take care of oneself can indicate that something is going on with the pts mental status -inattentiveness (this is often missed) -stupor
Polypharmacy
-alone not necessarily a risk factor for falls in OA -HOWEVER, if pt is on a *antiepileptic or benzodiazepine*, he/she is at risk for falls -So, be sure review med list & put pt on fall precautions if taking either of these drugs
*Delirium* risk factors in OAs
-any condition compromising brain function can cause ______ -older, sicker, and cognitively impaired are most vulnerable during hospitalization -illness, such as UTI, pneumonia, or simple dehydration can cause ______ -orthopedic and heart surgeries are well known risk factors for ________ -the very presence of an indwelling Foley catheter is enough to generate ________ -anticholinergic medications (tricyclics) are thought to be the primary drug-related cause (bc they block cholinergic transmitters in the brain) -OTC "home remedies"increase an elder's risk of _____; bc many have anticholinergic effects- some nasal sprays & cold/flu meds -newly prescribed medication or home remedy offend tied to _____/acute confusion; making this line of inquiry is essential to the nurse when obtaining history
As baby boomers enter the OA population
-average level of education will increase -will be more computer savvy -more knowledge of health than any generation -obesity and HIV status will be problems -group will see increased institutionalization as they age -gay seniors will become an increasing emerging trend
*Trigger behaviors* -assessment
-behaviors/changes in mental status that may occur in an OA that warrant further investigation -these are called ______ & should immediately cue the healthcare provider to find the cause -ex: delirium can become a geriatric syndrome which can lead to serious decline if untreated -unfortunately, if the person lives alone, these probs may not be identified until a crisis occurs that sends the person to the hospital -families of OAs need to be educated about the significance of changes in mental status & the need to seek medical attention ASAP
Life review
-beneficial in helping elders bring closure and growth to their lives -helps elders remember and process key events and relationships -comes natural to ppl drawing near end of life -not specified by age, may also be done by younger ppl at end of life -person is not only remembering event but also reflecting on how it made them feel -its reliving past experiences -purpose = to reintegrate past experience and to resolve conflict and repair relationship in prep for death =a good way for elders to accept even their mistakes and feel good about their lives
Delirium
-can be the starting point for the pt to fall over the edge into a downward spiral (geriatric cascade) -onset is always acute, developing over a short period of time (usually hrs - days) & fluctuates over the course of the day, often worsening at night -onset occurs shortly after admission to the hospital, usually b/w the 3rd and 6th day of hospitalization -clinical course of ____ is variable
Geriatric syndromes
-common conditions in older adults that may set pt up for other serious complications if hospitalization is required -by no means do these occur only in OA population HOWEVER problem is OAs generally have less physiological reserve -when they develop a pattern/1 or more of these _________, they are less able to recover from acute illness or injury without complications
Symptoms of depression in OAs 1. dementia 2. delirium
-decreased energy, motivation, interest -somatic complaints, weight loss -decreased appetite -some memory loss -insomnia or hypersomnia -critical and envious of others -decreased concentration; indecisiveness -loss of self-esteem and decreased sense of lifelong accomplishments -combative or resistent behavior -"model patient"- never uses call bell (you'll note several of these are also present in __1__ & __2__)
Standards of clinical gerontological nursing + = standards of professional gerontological nursing performance
-developed by ANA -emphasis is on outcomes, implying nurses are involved in diagnosis & research -8 ____+____ = quality of care, performance appraisal, education, collegiality, ethics, collaboration, research & resource utilization
Effects of ageism
-discrimination in the workplace & in access to health care/services -infantilization of the OA (can be even be done by well-meaning staff) -scapegoat for frustrated health care workers -blame of the victim (for his/her own physical/cognitive defects) -overly positive stereotypes
Role as nurse: adverse drug events- OA
-education & working w/ pt & caregiver to set up mechanism for safe med admin -referral to social services for financial assistance is another way to help pts in financial distress to obtain meds
Discrimination of OA (workplace & in healthcare) + = healthcare
-effect of ageism -creates social isolation for the elderly -some of the most negative effects of ageism happen in __+__
Overly positive stereotypes of the OA
-effect/type of ageism -ex: "cute little old man" -better if you try to learn something about them -we don't want to be judged by our looks & neither do OAs
1. Hispanic 2. 25%
-fastest growing segment in population = __1___ -by 2030 __2__ of elders in US will be minorities, many of whom don't speak english
Delirium management
-first of all, find the cause & treat it if possible -physical restraints should be avoided or used only briefly because restraints can cause or make _____ worse -check pt room for unnecessary items that could contribute to delusions; ex-artwork wouldn't be appropriate for a pt's room; any artwork can contribute to delusions and may need to be covered or removed if you have a _____ pt -planning effective communication strategies by nurses can provide pts w/ the info they need to maintain control & remain connected to their immediate environment -communication aimed at reorienting the pt to surroundings (this = key!); provide large, easily visible clocks & calendars- making sure its accurate; a board w/ names of care team members; the daily schedule; integration of orienting cues into pt's daily routine
John A Hartford Foundation for Geriatric Nursing
-foundation that has also created competencies that each nurse caring for OAs should meet (regardless of specialty) -competencies cover: communication, physiological and psychological age changes, pain, skin integrity, functional status, restraints, elder abuse, & discharge planning
Treatment for *depression*
-goal of tx is to decrease the symptoms and improve quality of life; ppl can die of _____ if its not recognized & tx, so decreasing mortality is another goal of tx -tx includes psychotherapy and medication w/ social and professional support for the pt -the bests meds for OAs are NOT tricyclics which have an anticholinergic affect but *SSRIs* which have less side effects than tricyclics -most ppl will recover from _______ if tx'd w/ combination therapy
Adverse drug reactions
-greater risk in OAs who are experiencing polypharmacy =5th leading cause of death in OAs -may suffer from falls from orthostatic hypotension due to meds they are taking -some drugs may have SEs that cause confusion, esp if inappropriate doses have been taken/prescribed -hepatic / renal toxicity can cause major acute medical problems
*Work ethic and consumerism* in North America- effects on ideas about aging
-identity of many people is tied to their work -so, when people retire/are no longer able to work, they may become viewed as "less valuable" bc no longer contributing to society -some ppl have attitude that the "old" are using up all the resources like Social Security/Medicare
Risk factors for OAs developing transient (temporary) incontinence
-immobility -impaired cognition -medications -diabetes -fecal impaction -stroke
Current aging demographic 1. 12.4% 2. aging 3. 77.4 YOA
-in 2006; __1__% of US = <65 YOA -society is ___2___ bc fertility rates are decreasing and life expectancy is increasing -in the 1900's, life expectancy = 40 YOA -in 2010, projected life expectancy = __3__
Dementia
-includes a plethora of disorders -is the 8th leading cause of death in late life -the most common form is Alzheimer's disease -other forms are vascular ______ & lewy body disease -sometimes will have a combination of types such as seen in an Alzheimer's pt who has a CVA
Alzheimer's + = dementia
-is progressive and irreversible -ranging from the early stages in which a person might have memory impairment, forgetting names, or losing familiar objects -although meds available to slow down the progression of the disease, eventually the pt, if he/she doesnt die from another cause, will lose the ability to walk, talk, or eat -its predicted that an epidemic of __+__ is beginning to happen world wide -presently, there are ~12 million people suffering w/ __+__ -by 2025, its estimated there will be 22 million & by 2050 almost 45 million!
Dementia pts
-may not be able to verbally communicate what they need; its up to the nurse to observe for clues that will help to identify needs; watch for patterns in expression, etc -be sure to communicate what you learn about the pt in the medical record and at the bedside so others can benefit as well -when _____ pt resists care, it may not only be bc they have a cognitive impairment; they may feel their privacy has been invaded(esp at bath time); OR they may have arthritic pain on movement that you aren't aware of -make caregiver approach more responsive to the individual's personal needs! -non-pharacological interventions to the environment may make a big difference in the _____ course -creating a routine, as much as possible in the hospital environment is the best thing you can do; bringing in familiar obj or family pics is also effective -education of the caregiver to available resources for support and long-range planning guidance are essential
Hayflick theory
-non-stochastic theory -suggest that we're all genetically programmed for specific life span -each cell is born w/ a limited number of relocations and when they run out the cell dies
Immunological theory
-non-stochastic theory -suggest altered B & T cells become "foreign bodies" and antibodies form to fight them -results in aging and death -may be underlying cause of autoimmune disease
Neuroendocrine theory
-non-stochastic theory -suggests organ control mechanisms are altered/lost over time as pituitary gland & hypothalamus "wear out"
Most common & potential life threatening *iatrogenic complications* in hospitalized elder
-nosocomial infections -pressure ulcers -depression -malnutrition -fecal impaction -delirium -incontinence
Gerontological Clinical Nurse Specialist (CNS)
-nurse has a masters degree -functions as a clinician, educator, researcher, or consult -is considered an expert in this field (gerontology) -demand for this role is increasing as demographics of aging change -degree offered at UTA
Gerontological/Geriatric Nurse Practitioner (GNP)
-nurse has masters degree (in the future will be required to have a doctorate) -function as primary care providers for elders or work in other healthcare areas -required to be certified by AACN -considered advanced practice nurses -degree also offered at UTA
Gerontologic Nurse Generalist
-nurse w/ basic entry level education who may provide/manage the care of OAs -this is usually the front line nurse in any setting -certification exam offered by ANCC
Iatrogenic/Geriatric cascade
-occurs when pt w/ at least one geriatric syndrome is admitted to hospital and instead of improving, he begins a downward spiral in condition, losing functional ability -occurs when there's a combo of: 1. frail elder 2. acute illness/ worsened chronic illness / injury (such as fractured hip) 3. stress of institutional care; hospitalization alone can start the ________ (downward spiral in a frail elder) -by the time OA is discharged from hospital, condition may be worse than when they came in -these = pts that may not be able to go home bc can no longer care for themselves -if we recognize those at risk, we can take steps to avoid ________
*Pain* misconceptions in OA
-often poorly assessed bc some professionals believe that ____ is a norm part of aging= NOT TRUE! -many also think that tx _____ aggressively will result in addiction OR that OA's can't take opiods w/o respiratory depression = ALSO NOT TRUE!
Postural hypotension
-one of the biggest unidentified problems in OA that results in falls -result from BP changes w/ changes in pt's position -normal changes in aging to the cardiovascular system can result in _______ -dehydration due to diuretics or changes in BP medication can also cause this
Pain
-one of the geriatric syndromes -chronic, persistant _____ is a problem for ~1/2 of the OAs who live in the community and for most of those living in nursing homes -many have multiple conditions causing ______ (ex; arthritis & peripheral vascular disease causing diff types of ____ at the same time) = whatever the pt says it is
Incontinence += urinary incontinence
-one of the geriatric syndromes -generally is a manifestation of another, more complex, condition -__+___ affects ~30% of OAs living in the community and ~50% of those living in nursing homes -__+__ = primary reason why ppl get sent to long-term care facilities; HOWEVER, its NOT a normal part of aging and is NOT inevitable -getting cause under control may improve ______!
Polypharmacy
-one of the geriatric syndromes -means that pt is taking many drugs or more than is clinically indicated -5 or more drugs is considered _____; typically the OA takes ~ 5 prescription drugs & 2 OTC (but some take 20 or more!); if OA is taking this many drugs, the likelihood of adverse drug reactions is high
Falls / falling + = 75 YOA
-one of the geriatric syndromes -most common and serious problem in OA's -associated w/ considerable mortality, morbidity, & functional decline -#1 reason for premature nursing home admission -figure out *WHY* the pt is ____ and take steps to correct the problem = answer to preventing premature nursing home admissions -not uncommon among OA's w/ orthopedic injuries (hip fractures) or surgery to become delirious, end up in a nursing home, etc. -_____ = leading cause of injury in elders -for those over __+__ who suffer a hip fracture _____, *50% will die w/in one year!* -consequences of a _____ are sometimes life threatening & often a _____ can be what tips a frail elder into the geriatric cascade; complications of decreased mobility set in, & the pt may lose independence, resulting in morbidity & possible mortality
The truths about aging 1. men 2. senile 3. exercise
-only 4.5% of seniors live in long-term care facilities -__1__ age 65 + are at the highest risk for suicide according to the CDC -the majority of old ppl age 65+ aren't __2__ &/or don't have defective memories, disorientation or dementia -never too old to __3__, even bed bound pts can __3__
*Pain* in OA + = hurting
-perception may be altered w/ aging, esp w/ cognitive impairment; nurses should be observant for other clues to determine that the pt is __+__ -we should assume that the majority of hospitalized pts have _____ & ______ eval should be done as a regular part of each assessment -research shows verbal _____ scales (ex: 1-10) are better than FACES type scale w/ OAs
Examples of problems associated w/ *uncontrolled pain*
-pt with ______ in ICU, may see tachycardia w/ increased myocardial oxygen consumption -can cause delirium, immobility, and splinting; which, may contribute to atelectasis (collapse of lung) or pneumonia +ex: elderly pt w/ sever osteoarthritis who can barely ambulate: if pt lives alone, may not be able to carry out norm ADLs; malnutrition & dehydration can occur if it's too hard to get to/from kitchen or to use a can opener
*Iatrogenic* complications
-result of pt receiving medical tx or hospitalization -up to 36% of all OAs admitted to hospital experience these w/ highest rate in ICU -pts 65+ suffer more diagnostic complications, medication reactions, therapeutic mishaps, & falls than younger pts -~1/2 of these complications are preventable -ex: pt immobilized for a while, becomes weak; bc putting at risk pt to bed w/o getting them up can be all it takes for pt to lose function and become deconditioned -hospitalization may lead to geriatric/________ cascade
Folstein Mini-Mental State Examination (MMSE)
-screening tool for cognitive status -has long been a standard assessment tool in dementia -have to have permission from authors for use -education, literacy, and culture affect results -takes 10-30 minutes to administer
Mini-Cog
-screening tool for cognitive status -more recently the ______ has been used as a quick, accurate screen for cognitive impairment -newer test: quick and easy for nurses to use -combines a 3-item word recall task with a clock drawing -it correlates well with the MMSE & in fact, appears to be somewhat more sensitive for dementia -several versions exist: ICU & telephone
Indwelling catheters + = intermittent catheterization
-shouldnt be used just bc a pt is incontinent UNLESS the pt is acutely ill or has full-thickness pressure ulcers -even ppl w/ urinary retention can be managed w/ __+__ -risk factors for pts w/ an _______ include not only UTIs but bacteria & trauma to the urethra; pts discharged from hospital w/ these conditions are likely to be readmitted
Cognitive impairment 1. delirium 2. depression 3. dementia
-some HCP's have difficulty distinguishing between dementia, such as Alzheimer's, and other probs like delirium and depression -many ppl wrongly assume that _____ is a normal part of aging; while it is true that there are changes to the brain that occur naturally with age; ______ is NOT a normal symptom -unfortunately many of these conditions go unrecognized/untreated bc of these beliefs -this is another example of ageism in the medical community -good news is, many pts can be treated and return to a normal life: --with __1__ just have to identify/tx the cause --for __2__ can be tx'd with psychotherapy and medication --there are even medications that mitigate the process of certain __3__ if they're diagnosed early enough
Why don't some ppl get treated for their depression + = depressed
-some think its a sign of weakness to ask for help, especially older men (hence the suicide rate!) -others go undiagnosed due to their HCP not knowing what to look for -others think its normal to be __+__ in old age -many lack the money to pay for tx; mental health has been the least paid service by medicare for yrs, although changes are afoot in that area, its still expensive to get therapy
Adverse drug reactions
-sometimes aren't recognized by HCP bc they may simulate the conventional image of growing old *++unsteadiness ++confusion ++incontinence ++depression* -all of these can be caused by ______ & is first area to explore when evaluating pt -area where stereotyping the OA can prevent in-depth assessment
Wear & Tear Theory
-stochastic theory -suggests repeated and random injury to cells, tissues, and organs result in aging
Error Theory
-suggests accumulation of DNA errors leads to cellular failure and eventually cellular death -stochastic theory
Depression
-the most common mental health problem in late life w/ about 30% of ppl who live in nursing homes suffering from ________ -~40% of all suicides are in ppl age 65+ w/ the highest group being older white men -probably the biggest reason why OAs become _____ is because of loss; loss of loved ones, friends, their homes, their abilities, perhaps even a pet; all can stimulate ____ that can last months-yrs in an OA -widowed women have a higher incidence of _____ due to grieving; remember, they tend to outlive their husbands
Hospitalization / hospitalized
-the older, sicker, and cognitively impaired are most vulnerable to experience delirium during _____ -& for pts who have sensory deficits, being _______ w/o glasses/hearing aides can begin the cycle
Symptom + = cause
-the thing to remember about delirium is that it is a ________ -if you tx the ______ w/ more medication to calm an agitated pt, you are probably adding to the problem -so the goal is to find the __+__ of the delirium & tx that!
Attitudes about work 1. aging 2. older adults 3. agrarian societies
-the work ethic and consumerism in North America affect our ideas about __1__ -the more industrialized a country, the lower the status of __2__ -in more __3__ the old tend to be honored and multigenerational families live together
Stochastic theories + = free radicals ^ = antioxidants
-theories of aging that propose aging events are random & accumulate w/ time -includes 3 dif theories: 1. suggests __+__ (product of oxidation of fats, proteins, or carbs) attach to other molecules and cause cellular damage; basis for the use of __^__ to prevent aging 2. wear & tear theory 3. error theory
OA generation 1. 4.5% 2. 30% 3. older women 4. minorities
-women generally live longer than men & will cause feminization of the elderly (nurses need to prepare to meet the needs of these women) -most live at home; only __1__% of OAs <65 live in long term care facilities; ~ __2__% live alone; we will see an increase in number of homeless elders with baby boomers -national poverty rate = 9.95% with number decreasing; __3__ & __4__ tend to have a higher poverty rate
Types of age
1. Chronologic 2. Functional
Theories of *aging*
1. Stochastic theories (random causes): free radical theory, wear & tear theory, error theory 2. Non-stochastic theories (less random): Hayflick theory, immunological theory, neuroendocrine theory *Regardless, exact cause of _______ is unknown!*
Screening cognitive status
2 tools are commonly used are: -Folstein Mini-Mental State Examination (MMSE) -Mini-Cog
Advertising agencies + = ads
= a significant contributor to ageism -__+__ dwell on problems of OA (incontinence/impotence) -prey on fear of OA if you fall= nursing home (ex-UNLESS you have a medic alert necklace) / fear of disease (ex- marketing shingles dz tx)
Standard of practice for *pain* management in OAs requires
All OAs: -will either be free of ____ OR -their ______ will be controlled to a level acceptable to the pt -this allows the the elder to maintain at the highest level of functioning possible
Acute & chronic illness
Can all contribute to falls in OA, specifically: -cardiac arrhythmias -fever -visual disturbances -cognitive impairments
Causes of increase in life expectancy
Caused by medical advances: -antibiotics & immunizations -diagnostic tools revealing problems sooner -life prolonging technology (ex- dialysis)
Lewy body disease
Dementia caused by head trauma or anoxia
Vascular dementia
Dementia that might be caused by a stoke/CVA
Chronologic age
How many years a person has lived
Possibilities of *delirium*
In OA either leads to either... 1. full recovery w/early detection & intervention 2. progression to stupor &/or coma, seizures, and death -recovery is the most common outcome & in most cases completely resolves w/in 1-4 wks -bc the act of hospitalizing a pt is enough to cause ______ in some ppl, getting the pt out of bed on a regular basis can help to restore mental status; this will also help to prevent functional decline
Perceptual disturbances
In OA experiencing delirium, _______ may also develop: -often are accompanied by delusional (paranoid) thoughts, which make the condition even more significant, further contributing to behavioral and emotional manifestations -delusion is based on something real: ex- a moving curtain that the pt thinks is a person -paranoid thoughts might occur if the pt believes the nurse intends to harm him/her -a hallucination isn't caused by something real but comes out of the pt's imagination -*generally the delirious pt may suffer from delusions or paranoid thoughts*
Nursing factors to avoid/ prevent pt Falls:
Include: -providing good lighting -avoid slick or wet floors -finding assistive devices; such as chairs w/ arms, etc. + recognizing intrinsic or internal risk factors w/in the pt: more dif to control but also extremely important
Related factors- Polypharmacy
Includes: -physicians who prescribes a new med for each new symptom w/o reviewing the entire med list -OR physician may order automatic refills w/o reviewing med list on a regular basis -pts often see several specialist who may not be aware of what others have prescribed -some pts have prescriptions w/ dif pharmacies to capatalize on discounts resulting in no one pharmacist ever analyzing entire med list -many pts now taking supplements and herbs, which can interact w/ prescription medication +++All this = why it is significant for nurses to review all prescription and non-prescription drugs and supplements upon admission/each time a new drug is added; enlist aid of pharmacist in evaluating potential threats to pt
Life expectancy
Measure of overall health status of a population
Chronicity
OAs already "primary consumer" for hospitals w/ _______ (presence of chronic disease) such as DM or HTN a huge factor in health care now
Patients role in adverse drug events
OAs role: -ability to take meds correctly; visual probe, arthritis, illiteracy, or impaired cognition = dif for elderly to self-administer meds -cant afford to fill prescriptions so they skip or have 1/2 does or even share w/ a spouse OR might choose to buy food before purchasing meds
1. attitudes 2. actions
Our __1__ toward aging determines/influences our __2__
People at risk for *depression* later in life
People who have: -low incomes -chronic illness & pain -live alone -if they have a history of ______ or alc abuse the risk is even higher
1. 1920 - 1930 2. 1940-1955 3. 1950- 1960 4. 1946- 1964
Ppl born w/in same decade or time period often described by other factors, examples: -men born b/w __1__ = WWII & Korean war cohorts -men born b/w __2__ = Vietnam cohorts -women born b/w __1__= "traditional" cohort -women born b/w __3__ = women movement cohort -__4__= baby boomers; 74.1 million in this generation
Uncontrolled pain
Significant because its associated with: -depression -sleep deprivation -social isolation -constipation -ALSO contributed to functional loss w/ pt becoming increasingly dependent on others for his/her care
Communication with older adults + = elder talk
Study on Alzheimer pts showed.. -dont use baby talk AKA "honey/sweety" (patronizing communication) also referred to as __+__ -when this was used, pts was twice as likely to become non-cooperative w/ staff -when addressed in normal adult tones & language, they became cooperative again
Ageism
The process of systematic stereotyping, discrimination, or prejudice against persons based on the characteristics of age
Intrinsic/internal risk factors r/t *falling* in OA
These risk factors are more difficult to control but also extremely important, these include: -postural hypotension -impaired mobility, gait, &/or balance -acute & chronic illness -polypharmacy
Depression in OAs
______ develops slowly but usually occurs with other events such as: -a serious illness (like cancer) -other conditions that cause the pt to lose the ability to live the way they used to (like CVA causing paralysis OR macular degeneration) -hormonal changes as well as certain vitamin and mineral deficiencies can also contribute to ______ -ex: hypotension can make a person feel ______; so the tx is simple-get rid of the hypotension!
