Chapter 16 - Older Adult Assessment

*Atypical Disease Presentation (cont.)* (1) Depression (a) ____ of men & ____ women (b) _____ with age (c) manifested by ________ (d) NOTE: suicide in elderly men is _______

(1) (a) 11%; 18% (b) increases (c) multiple physical complaints (d) usually successful

*Health Status* (1) Chronic health conditions (a) hypertension _____ (b) arthritic symptoms _____ (c) heart disease ____ (d) cancer (e) diabetes

(1) (a) 54% (b) 49% (c) 32% (d) 22% (e) 19%

*Prescription History*: (1) Rx and OTC (a) ____ and _____ (2) Poly-pharmacy (a) (3) Toxic drug level reactions can occur at ________ (4) increase in _______ (5) _______ reactions

(1) (a) antacids and laxatives (2) (a) taking more than one drug (3) normal blood levels (4) allergic reactions (5) paradoxical

*Health Promotion (cont.)*: (1) Senior centers (a) _____ and ____ plan (b) (c) (d)

(1) (a) assessment; health promotion (b) goals (c) implementation (d) evaluation

*Health Promotion*: (1) promotion of health: (a) annual _____ vaccine (67%) (b) _______ vaccine (60%) (c) regular _____ (22%) (2) health risks (a) 11% ______ (b) 4% ______ (c) 24-35% _____ (d) Diet - too high in ____ , ____ , ____

(1) (a) influenza (b) pneumonia (c) exercise (2) (a) smoke (b) alcohol (c) obesity (d) salt, sugar, fats

*Normal Changes of Aging (cont.)*: (1) Genitourinary Changes (a) _____ bladder capacity (b) (c) _____ activity (d) ______ - ________ (2) Diabetes Mellitus (a) diminished ability to _______ (b) _____ - atypical (3) Hypothyroid (a) ______ hair & skin (b) _____ intolerance (c) (d) (4) NOTE: _______ is NOT a normal change

(1) (a) small (b) nocturia (c)sexual (d) BPH - benign prostatic hypertrophy in men (2) (a) metabolize CHO (b) signs & symptoms (S&S) (3) (a) dry (b) cold (c) fatigue (d) constipation (4) incontinence

*Cost of Health Care*: (1) _____ of annual income (a) _____ for insurance (b) ______ for drugs (c) _____ for healthcare services (d) _____ for healthcare supplies

(1) 13% (a) 53% (b) 27% (c) 16% (d) 5%

*Sensory Assessment*: (1) Hearing - (2) Vision - (3) _____ ability (4) Memory (5) May effect _______ (a) if extensive - difficult to ...

(1) 36% (2) 17% (3) writing (4) (5) health history (a) remember all details

*Overall Health Self-reported*: (1) over age 65 good to excellent - ____% (2) over age 85 good to better - _____% (3) false teeth ______%

(1) 75 (2) 66 (3) 25

*Multiple health problems*: (1) ______ deficits (a) 1 or more - ____% (b) nursing home resident - ____% (2) _______ chronic illnesses is common (3) decrease in ______ (4) infection + diminished reserve = _____ or ____ (5) history of _______ (a) (b)

(1) ADL (a) 42 (b) 4 (2) 3-4 (3) immunity (4) death or disability (5) rare diseases (a) polio (pre-vaccine) (b) TB

*Normal Changes of Aging*: (1) (2) _____ loss - _______ sounds (3) Skin changes (a) _____ skin (b) skin _____ (c) (4) ______ problems - ______ (5) Cardiovascular (a) ______ reserve (b) irregular _______ (c) Orthostatic ______ (6) Gastrointestinal (a) decrease in _____ , _______ , _____

(1) Cataracts (2) hearing; high pitch (3) (a) onion (b) tears (c) dehydration (4) joint; safety (5) (a) diminished (b) heart beat (c) hypotension (6) (a) peristalsis, stomach acid, saliva

*Fall Risk*: (1) (2) (3) (4) mobility problems due to: ______ , _____ , ______ (5) skin integrity issues: due to _____ , ____ , ____ (6) fill out ______ (7) maintain proper ______ (8) older adults are at increased risk for ______ ; which is the leading cause of ______ for those over _____ years old

(1) Home (2) Hospital (3) Long-term care (4) arthritis, gait, balance disorders, cataracts (5) falls, problems with positioning, incontinence (6) Braden Scale (7) skin care (8) falls; injury death; 65

*Abuse of medications*: (1) _______ - most abused by ______

(1) Laxatives; elderly

*Assessment* (1) ______ is high to ______ changes ( _____ ) (2) _______ can be life threatening (3) takes longer to _____ and _____ (a) need to ______ teaching (4) self care can be affected by _______ and ______

(1) adaptability; slowly developing; (20-30 years) (2) acute changes (3) learn; remember (a) reinforce (4) meds; medical conditions

*Other Changes*: Osteoporosis (1) loss of _____ (2) is not ____ but ______ (a) especially _____ (b) _____ , ____ (c) early _____ (d)

(1) bone density (2) a normal change; prevalent in elderly (a) women (b) small frame; white (c) early menopause (d) smokers

*Social History*: (1) Aging is a _______ process (2) assess _______ (3) use of ____ , ____ , _____ (4) a series of ____ (a) (b) (c) (d)

(1) decremental (2) support systems (3) tobacco, alcohol, drugs (4) losses (a) death of friends (b) job (c) role changes (d) home

*Mental Health (cont.)*: (1) mental disorders (mainly _____ ) are ______ in older adults (2) only _______ of community-dwelling older adults are depressed and ____ who are chronically ill are depressed (3) ___________ have the highest rate of suicide (4) symptoms of depression in older adults: _______ , ______ , ______ (5) Risk factors for depression: ____ , ____ , ______ , _____ (6) existential depression: ______ , _____ , ______ , _______ (7) may need _____ or _____ (8) looses sense of ____ , ______ , ____

(1) depression; misdiagnosed (2) 2%; 9% (3) older adult white men (4) poor cognitive performance, sleep problems, and lack of initiative (5) loss, change in environment, alcohol or substance use, chronic pain (6) death, freedom, isolation, meaninglessness (7) medication; therapy (8) self, importance, independence

*Other Changes*: (1) women and ____ loss (a) ____ vagina & labia (b) vaginal ______ ( ________ ) (c) loss of _____ can lead to _______

(1) estrogen (a) itchy (b) bleeding (*is NEVER a normal symptoms and requires further investigation*) (c) estrogen; osteoporosis

*Cause of Death* (1) (2) (3) (4) (a) (b) (5)

(1) heart disease (2) cancers (3) stroke (4) chronic respiratory illness (a) COPD/ emphysema (b) pneumonia (5) diabetes mellitus

*Nutrition*: (1) ______ level (2) _______ preparation (3) ______ ability (4) ______ & _______ ability (5) older adults with poor nutrition are at risk for ________ , ______ , _______ (6) better to be _______ than ______ as an older adult (7) reasons for weight loss in institutionalized older adults: _______ , ______ , ______

(1) knowledge (2) food (3) shopping (4) chewing & swalloing (5) complications from acute and chronic illness, medications, environment "onslaughts" (6) a little chubby; too thin (7) depression, use of anorexigenic drugs, dependence of staff for feeding

*Loss and Grief, loneliness, and coping and stress*: (1) ________ losses as we age (2) expect _____ with losses (3) loss of importance relationships results in _______ (4) sensory losses can _____ individuals (5) social isolation exposes older adults to the potential to be ______ & ______ (6) consider older adults previous ways of coping with stress and how they now cope with stress -> may need to ________

(1) multiple (2) grieving (3) loneliness (4) isolate (5) abused & neglected (6) find alternative methods

*Multiple Health Problems (cont.)*: (1) chronic illness can affect one's _______ (2) poor nutrition and chronic illness affect ______

(1) nutritional status (2) immunity

*Cognitive/Emotional*: The 3 D's (1) Depression - (2) Delirium - (a) (b) (3) Dementia -

(1) pandemic problem (2) reversible dementia (a) illness, drugs, hospitalization (b) history of delirium of dementia (3) slow progressive, irreversible loss of cognitive function

*Atypical Disease Presentation*: (1) related to - (2) " _____ " (3) Pneumonia - lung infection (a) changes in _____ (b) loss of _____ (c) no ______ or _____ until late in the disease

(1) poor immune response (2) diminished reserve (3) (a) cognitive ability (b) appetite (c) fever; mucous

*Mental Health*: (1) history of _____ ? (2) view of _______ (some people think their a ____ ) (3) feelings of ______ (4)

(1) problems (2) mental health professionals; hoax (3) loss (3) hospitalizations

*Cognitive/Emotional*: The 3 D's (cont.) (1) reality orientation is recommended for those with ________ ( _____ ) (2) validation therapy is recommended for those with ______ ( _____ ) (3) ______ and _____ may be used to treat depression and adverse behavioral symptoms associated with dementia (i.e. Asking the same questions, anxiety, emotional lability, hoarding, irritability, misplacing things, physical aggression, socially/sexually inappropriate behavior, paranoia, undressing in public, verbal aggressiveness, wandering) (4) For the most part, don't take _______ with dementia* (risk of ____ ), some situations have to weight out positives and negatives

(1) reversible confusion (delirium) (2) irreversible confusion (dementia) (3) Antipsychotic and Antidepressants (4) antipsychotics; stroke

*Incontinence*: (1) urge and reflex incontinence may cause older adults to ______ and result in a _____ (2) _______ have more incontinence issues than older men ( ________ )

(1) rush to the bathroom; fall (2) older women; multiple pregnancies

*Rest and Sleep*: (1) ________ are common in older adults (2) increase in _______ and decrease in ______ (3) encourage _______: - - - - - - - -

(1) sleep disturbances (2) stage 1 sleep; deep sleep (3) good sleep habits ◦Avoid alcohol, nicotine, and caffeine ◦Avoid exercise 3 to 4 hours before bedtime ◦Avoid frequent napping ◦Avoid large meals and excitement prior to bed ◦Maintain a routine ◦Sleep in a cool, quiet environment ◦Upon awakening, GET UP! ◦Use bed for sleeping or intimacy only!

*Pain Management*: (1) _______ in older adults and ______ with advancing age (2) those institutionalized have ____ pain that is _____ and often _____ (3) most commonly caused by ________ (4) barriers to pain management: (a) ignorance about _____ (b) lack of _____ about _____ (c) _____ (d) belief that older adults ________ (e) failure to ______ and _____ pain in _________ older adults (5) Untreated pain causes (a) decreased ______ (b) ____ (c) decreased _____ (d) ____ ideation (e) decreased ____ (f) increased _____ , _____

(1) very common; increases (2) significant; unrecognized; untreated (3) osteoarthritis (4) (a) addiction (b) knowledge; dose management (c) tolerance (d) experience less pain (e) assess; treat; cognitively impaired (5) (a) quality of life (b) depression (c) socialization (d) suicidal (e) appetite (f) healthcare utilization, cost

A 90 year old person may still engage in and enjoy sexual experiences. A. True B. False

A

Which group of individuals has the highest rate of suicide in the United States? A. Older white men B. Older white females C. Older African American males D. Older Hispanic males

A

The nurse is preparing a presentation on chronic pain management to a group of elderly members of a community senior citizens center. Which chronic disease should the nurse focus on in her presentation? A. Rheumatoid Arthritis B. Osteoarthritis C. Amputation D. Neuropathy

B

The hospice nurse is visiting the elderly wife of a patient 4 weeks after the patient died. Which of the following comments by the wife concerns the hospice nurse the most?' A. "I haven't started cleaning out my husband's closet yet." B. "It is so hard to think I won't see my husband again." C. "Sometimes I just sit and cry." D. "Eating alone is so lonely. I just lose my appetite when I think about it."

D

Which group of individuals in the elderly population are most likely to be widowed? A. Women under the age of 65 B. Men under the age of 70 C. Men over the age of 75 D. Women over the age of 75

D

Diversity: ◦As the older population grows in number, it will also grow more diverse. In 2017, 23% of Americans 65 and older part of a racial or ethnic minority population (ACL, 2018). ◦It is estimated that up to 2.4 million Americans over the age of 65 identify themselves as LGBT in the United States and that this number is projected to grow significantly.

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Health and health care ◦In 2018, 46% of noninstitutionalized older adults assessed their health as excellent or very good compared to 65% of people ages 18 to 64 years. ◦Most older adults have at least one chronic condition, and many have multiple conditions. ◦In 2017, 93% of noninstitutionalized people of age 65 and over were covered by Medicare, and approximately 51% also had some type of private insurance.

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Income: as of 2017 ◦Households with families headed by persons 65 years or older reported a median income of $32,654 for males and $19,180 for females. ◦9.2% were below poverty level. Another 4.9% were classified as "near poor," with income between the poverty level and 125% of this level. ◦Older women had a poverty rate of 10.5% versus 7.5% of men. Older persons living alone were much more likely to be poor (16.7%) than were older persons living with families (5.7%). ◦In 2018, 19.6% of older Americans were working or actively seeking work.

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Marital status and living arrangements: ◦In 2018, 70% of older men and 46% of older women were married and living together. There were over three times as many widows (8.9 million) as widowers (2.6 million). ◦A relatively small number (1.2 million) of the 65 years or older population in 2017 lived in institutional settings such as long-term care facilities, the percentage increases dramatically with age, ranging from 1% for persons 65 to 74 years to 3% for persons 75 to 84 years to 9% for persons 85 years or older. ◦In 2017, more than half of noninstitutionalized older adults lived with a spouse (72% of older men and 48% of older women).

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Population growth: ◦In the United States, one in seven Americans is 65 years or older. ◦In 2017, the United States had 50.9 million people who were 65 years and older, which accounts for roughly 15.6% of the total population. ◦By 2060, approximately 90.7 million U.S. citizens will be considered part of the older population, the largest proportion on record with the 85 years and older group expected to increase 123% to 14.64 million in 2040. ◦Life expectancy: In 1900, life expectancy was 47 years; for a child born in 2016, it was 78.7 years.

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