Family Caregiving-geri exam 2

An individual who who assists someone in need of care who lives more than 1 hr away is considered a a. distant relative b. long-distant caregiver c. regular caregiver d. remote family memeber

b. long-distant caregiver

Most of the home care of older persons is provided by a. formal agencies b. religious leaders c. family members d. family friends

c. family members

sandwich generation "hidden patient"

care for both parents and children

which kind of children may be reluctant caregivers to these parents in old age.

children who feel their parents were insensitive to their needs throughout their lives may be reluctant caregivers to these parents in old age.

The nurse is completing an admission assessment with an 80-yearold man who experienced a hip fracture following a fall. He is alert, lives alone, and has very poor hygiene. He reports a 20-pound weight loss in the last 6 months following his wife's death, as well as estrangement from his only child. He admits to falls before this most recent fall. What should the nurse suspect? a. Dementia. b. Elder abuse. c. Delirium. d. Alcohol abuse.

d. Alcohol abuse. rationale: Hallmarks of alcohol abuse include frequent falling, self-neglect, and poor nutrition, which could result in weight loss and may accompany depression and loss.

A disabled woman, older than 75 yrs, who lives with a relative & is physically dependent on others is at risk for:

elder abuse

In caregivers' TLC, the C stands for:

*Caring* -- Caring for themselves, ex: sleep, nutrition, socialization.

TRUE/FALSE The nurse only needs to intervene once to resolve an incidence of elder abuse.

*FALSE* Ongoing interventions are necessary to prevent future abuse, even after the immediate episode has been resolved.

In caregivers' TLC, the L stands for:

*Leaving* -- Leaving the care situation periodically to obtain respite and relaxation.

Who are sandwich generation?

*Middle aged* persons who are *caring for* their *own children* and their *parents*.

TRUE/FALSE Most older people and their families prefer to live near but not with each other.

*TRUE*

In caregivers' TLC, the T stands for:

*Training* -- Training in care techniques, safe medication use, recognition of abnormalities, and available resources.

What are some positive experiences grandparents have from grand parenting?

- obtain enjoyment - obtain affection - obtain sense of purpose

Which groups of people are most known to be caregivers?

- wives - daughters & daughter in laws

What is the estimated number of people involved in parent care?

10 million

how many elderly suffer some form of abuse annually in the U.S.?

2 million,

What percentage of caregivers are 65 yrs or older?

45%

About how many Americans are long-distant care givers?

7 million

family members provide __% of care for older adults in the US

80

who is at greater risk for abuse ?

>75 years of age, disable woman who lives with relative and is physically , socially, or financially dependent on others.

A family has decided to care for a grandparent with terminal cancer in the daughter's home. Family caregiving is new to the family. When helping this family as they begin to plan for their caregiving roles, what are the two top priority assessments to best learn about family functioning? (Select all that apply.) a. Communication b. Decision making c. Development d. Economic status e. Family structure

A, B rationale: Understanding how the family communicates and makes decisions are priority assessments. This information will help to establish goals of care, how care will be provided, who provides the care, which resources are needed, and when to ask for additional help. Although the other factors are important, these two have priority and will assist in understanding the impact of other factors on family function and caregiving in this situation.

What is the function of a geriatric care manager?

Assess a person's needs and coordinate care locally for the family

Once the nurse suspects abuse, he/she should:

Assess the degree of immediate danger and take appropriate actions.

A nurse is assessing an older adult brought to the emergency department following a fall and wrist fracture. She notes that the patient is very thin and unkempt, has a stage 3 pressure ulcer to her coccyx, and has old bruising to the extremities in addition to her new bruises from the fall. She defers all of the questions to her caregiver son who accompanied her to the hospital. The nurse's next step is to: a. Call social services to begin nursing home placement. b. Ask the son to step out of the room so she can complete her assessment. c. Call adult protective services because you suspect elder mistreatment. d. Assess patient's cognitive status.

B. rationale: The assessment leads you to suspect elder mistreatment, but the nurse needs more information directly from the patient before calling social services or the adult protective services. She will best get this information by asking the son to leave so she can ask the patient direct questions privately. If the son refuses to leave, this will be another indication that elder mistreatment may be occurring. Cognitive testing will be important but is not the priority.

A home care nurse suspects that a client's spouse is experiencing caregiver strain. Which nursing action will assist in supporting the nurse's suspicion? a. Obtaining feedback from the client about the coping abilities of the caregiver. b. Gathering subjective and objective assessment from the caregiver and the client c. Making a referral to the home care agency social worker to complete the assessment d. Interviewing family members regarding their concerns for the health and well-being of the caregiver

B. rationale: To assess for caregiver strain, the nurse should gather subjective and objective data from the caregiver and the client. The nurse should not expect the client or family members to assess the coping abilities of the caregiver. Although a social worker may be helpful, the nurse needs to perform the assessment of the situation before making the referral.

Why would the burdens faced by family caregivers continue to grow?

B/c more people are reaching the old-old years.

Which of the following family assessments are most important for successful family caregiving? (Select all that apply.) a. Educational level of family members b. Cultural food preferences c. Collaboration between family members d. Social support e. Conflict resolution practices

C, D, E rationale: For successful family caregiving, members of the family must collaborate and use conflict resolution strategies to divide the workload, make decisions, identify recreational activities, etc. A support system is important to help individual members and the entire family deal with the some of the high demands and challenges of family caregiving.

In viewing the family as context, what is the primary focus? a. Family members within a system b. Family process and relationships c. Family relational and transactional concepts d. Health needs of an individual member

D. rationale: When you view the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). Although the focus is on the individual's health status, it is also important to assess how much the family provides the individual's basic needs.

When should the nurse recommend that the care giver plan their trip to visit?

During the time of medical appointments

tools for assessing elder abuse

Elder Assessment Instrument (EAI)

TRUE/FALSE When interviewing older adults the nurse should not consider persons beyond traditional family members to be a significant other.

FALSE It is important for the nurse to explore all persons who are "significant others" to an individual.

What is a *skipped generation household*?

Household in which grandparent is raising minor grand child with no parent present.

The *decision maker* in the family is the person who

Is called on in times of crisis. They are consulted for problem solving

Which caregiver group is especially vulnerable?

Middle aged daughters

nurse's role

Nurse's Role • Assessment- Family members and history— strengths and weaknesses, coping, cultural values, support systems, family dynamics - "Do you fell overwhelmed as a caregiver?" - "Do you feel isolated?" - "Do you have any other family members helping you?"

Which components of health should be evaluated to ensure that the caregiver is competent to provide care?

Physical, emotional and social health.

caregivers need TLC

T-training L-learning C-caring

TRUE/FALSE The rate of divorce in older adults is increasing, but still remains low.

TRUE

TRUE/FALSE Today the average woman will spend more time caring for her parents then her children.

TRUE

TRUE/FALSE Negative roles can be fostered by and meet certain needs of the family

TRUE Think of the financially secure son who is boring, versus the broke freeloading son who is fun to be around and gives his parents a sense of being.

Elder abuse is defined as

The infliction of physical or emotional harm, neglect, financial exploitation, sexual mistreatment, or abandonment of an older adult.

The *caregiver* is

The person who assists with personal care and home management.

Should the gerontological nurse evaluate the health of all family members? Why or Why not?

YES ! Effective gerontological nursing recognizes that the health of all family members must be maintained and promoted.

A "club sandwich" generation is

a generation of care givers who care for aging parents, children, and grandchildren or grand parents

The *Victim* is

a person who forfeits his or her legitimate rights and may be physically, emotionally, financially, socially, or economically abused.

Which question is best for a long-distance caregiver to ask during a telephone call? (select all that apply) a. What time did you go to sleep? b. When did you last go grocery shopping? c. What are you currently wearing? d. Have you had contact with anyone?

a, b, d

Subtle clues of abuse include: (select all that apply) a. malnutrition b. neat clothes c. inability to maintain or gain weight d. depression e. poor concentration

a, c, d, e.

What are some clues to potential abuse?(select all that apply) a. changes in mood b. excessive talking c. missing valuables d. injuries

a, c, d.

rewarding of family caregiving

a. a caring , interested family is one of the most valuable resources an individual can posses in old age b. caregiving can add a unique depth and meaning to the family c. opportunities for relatives to learn more about each other d. gratification in giving back to the aged

diversity of family structure including?

a. couples b. couples with children c. patent and child or children d. sibling e. groups of unrelated individuals f. multigenerations

family member roles

a. decision-maker: making important decision in times of crisis b. caregiver: provides direct servies c.deviant:"problem child" who has strayed from family norms d. dependent: depends on the other members of the family for economic or caregiving assistance e. victim: person who forfeits丧失，失去 his or her legitimate rights and may be physically , emotionally, socially or economically abused by the family.

why an individual's aging process affect on the entire family unit?

a. family are absorbing more complex responsibilities over longer periods of time b, many families today do not reflect the stereotypical nuclear family c. Greater numbers of families are providing or complex care for their older members for longer periods of time than ever before.

need to explore the following issue:

a. how family members feel about each other b. the manner of communication c. attitudes, values and beliefs:do they feel that the young should take care of the older or that children own their parents nothing? d. links with organizations and the community

type of abuse

a. infliction of pain or injury b. withholding of food, money, medications or care c. confinement, physical or chemical (drug) restraint d. theft or intentional mismanagement of assets e. sexual abuse f. verbal or emotional abuse g. neglect.

skipped generation households

grandparents raising kids w/o their parents present

which ethnicity has highest % of households with a caregiver?

hispanic then african american then white

subtle clues of abuse

malnutrition, failure to thrive , injuries, oversedation, and depression

who is a paritcularly vulnerable group of caregivers?

middle-aged daughters. may need home health to assist in care should know options available

long distance

more than 1 hour away

family caregiving

most of home care of older adults is provided by family members , not formal agencies.

who are caregivers of older person frenquently?

senior citizen themselves. e.g. my neighbor: silvia

The *deviant* is

the family scapegoat. The one who has strayed from family norms

What should nurses advise long-distance caregivers about?

what issues they should review during telephone calls that can aid in identifying risks, needs, and changes in status.

positive benefits of caregiving

• "Give Back" to a loved one • Fulfillment of family roles • Increases self-esteem and well-being • Personal growth and satisfaction • Finding meaning through caregiving • ***Caregivers who have a positive relationship with the care recipient experience less stress and find caregiving more meaningful**

charachteristics of a caregiver

• 73% are female • Role changes for both male and female caregivers • 45% of caregivers are 65 years or older • Nearly ½ are wives, then daughters/daughters-in-law • Types of assistance provided: Managing and cleaning the house, laundry, finances, grocery shopping, errands, medical appointments

support the caregiver

• Educate yourself as much as possible about the disease • Consult others experts to plan for the future • Use community support/resources • Explore religious beliefs and values • Set realistic goals • Research reveals best outcomes with psychosocial support and education/skills training

caregiver needs

• Finding time for oneself • Balancing work and family responsibilities • Managing stress • Learning how to talk to physicians • Making end-of-life decisions • Managing the challenging behaviors • Managing complex medication schedules

how to reduce stress of the caregiver

• Reinforce social supports: - TLC model: Training, Leaving, and Caring • Encourage group participation with other caregivers • Assist in finding respite sources • Encourage caregiver to maintain activities important to his/her well-being • Allow the caregiver to express feelings • Letting go of things that have not gone well

negative consequences of caregiving

• Stress—Physical and Emotional • Social Isolation • Frequently experience depression and physical and emotional exhaustion • May lead to the caregiver to postpone his/her needs (Hidden Patient)

nursing interventions

• Thorough family assessment - Roles, dynamics • Help the caregiver identify and utilize support systems • Encourage the caregiver to grieve the loss of function of the loved one • Encourage the caregiver to schedule and keep regular health care appointments • Encourage regular communication with the care recipient and the health care team

charachteristic of average caregiver

• Usually adult children • 49 years old, married, working outside the home • Median income $54,000 • 50% of women will at some point in their lives be a caregiver of an older adult • 45% of caregivers are 65 years of age or older