Chronic Illness and Older Adults

The incidence of chronic illness triples after age?

45

Young Old Adult

65 to 74 years

Old Adult

85 years of age and older

Family members are responsible for up to _____ of domestic EM.

90%

Acute

Active illness with severe and unrelieved symptoms or complications. Hospitalization may be required for management.

Tertiary Prevention

Activities that limit disease progression such as rehabilitation.

In which of the following situations is the nurse legally obligated to report EM?

Actual EM, abandonment, suspected EM, patient request

A patient went to visit a friend who has a cat. The exposure to cat fur triggered an asthmatic attack in the patient. The patient was admitted to a hospital for the management of shortness of breath. Which phase of the trajectory model of chronic illness did the patient go through?

Acute

Medication Errors

Administration of both brand and generic medications, refilling medications too soon or too late, and drug-drug interactions.

Relocation Stress Syndrome

Associated with the disruption, confusion, and challenges that older adults face when moving from one environment to a new environment. Older adults may experience anxiety, depression, and disorientation.

Psychologic Abuse

Berating verbally, harassment, intimidation, threats of punishment or deprivation. Childlike treatment, isolation.

Renal Function

By age 75 to 80, there is a 50% decline in the renal clearance of drugs. Older adults with altered renal function may need a lower dose and/or decreased frequency of administration of a drug excreted by the kidneys.

Programs for All-Inclusive Care for the Elderly (PACE)

Care for adults age 55 and older. Services include primary care including prescription medications and wound care, physical, occupational, recreational, and speech therapy, adult day care, dental, podiatry, social services and home health care.

Frailty

Clinical syndrome seen in older adults. Clinical manifestations include unintentional weight loss (>10lbs in a year), self reported exhaustion, weakness, slow walking speed, low level of physical activity. At risk for malnutrition and dehydration.

Leading Cause of Death

Coronary Artery Disease

Home Health Care

Cost-effective care alternative for older adults who are homebound, have health needs that are intermittent or acute and have supportive caregiver involvement.

The family of a patient asks the nurse what services will be provided by adult day health care centers. What is the best response by the nurse?

Daily supervision, personal services, recreational services

Short Term Memory

Declines with old age

Causes of Medication Errors by Older Adults

Decreased vision, forgetting to take drugs, use of nonprescription OTC drugs, use of medications prescribed for someone else, lack of financial resources to obtain prescribed medication, failure to understand instructions or importance of drug treatment, refusal to take medication because of undesirable side effects

Hepatic Blood Flow

Decreases markedly with aging, and the enzymes largely responsible for drug metabolism are decreased as well.

Which condition describes an older adult who has been hospitalized after demonstrating an acute change in mental status?

Delirium

Financial Abuse

Denying access to personal resources, stealing money or possessions. Coercing to sign contracts or durable power of attorney. Making changes in will or trust.

Violation of Personal Rights

Denying right to privacy or right to make decisions regarding health care or living environment. Forcible eviction.

Abandonment

Desertion of an older person by an individual who has assumed responsibility for providing care or by a person with physical custody.

Adult Day Health Care

Designed to meet the needs of older adults and people with disabilities who need a higher level of care

When teaching a patient about primary prevention of a chronic illness, the nurse focuses on which topic?

Diet

Risk Factors: Frailty

Disability, multiple chronic conditions, and dementia.

Chronic Illnesses

Diseases that are prolonged, do not resolve spontaneously, and are rarely cured completely.

Acute Illnesses

Diseases that have a rapid onset and a short duration. Ex: Colds, influenza, acute gastroenteritis

The most dramatic changes with aging are related to:

Drug metabolism

Transitional Care Model

Evidence-based, innovative approach to care coordination and management of the complex needs of older adults. Those most likely to benefit include those of older age and those with functional deficits, behavioral or psychiatric issues, multiple chronic conditions, a need for polypharmacy, a recent hospitalization, lack of a support system, low health literacy, and history of nonadherence to treatment.

While assessing an older adult with chronic heart disease, a nurse notices signs and symptoms of depression. The nurse encourages the patient to seek treatment. What are the effects of depression in an older adult?

Exacerbated medical conditions

Management of Medications

Face difficulty because of cognitive impairment, altered sensory perceptions, limited hand mobility or dexterity, and the high cost of drugs

Neglect

Failure to provide basic life needs, including food, water, medications, clothing, hygiene. Failure to provide physical aids such as dentures, eyeglasses, hearing aids. Failure to ensure safety. Failure to provide social stimulation. Leaving alone for long periods. Failure to provide companionship.

Conditions that most commonly result in hospitalization:

Falls, dysrhythmias, heart failure, stroke, fluid and electrolyte imbalances, pneumonia, urosepsis, and hip fractures.

During a home visit, the nurse learns that an older patient spends time alone and has fewer personal belongings than on previous visits. The patient says, "My son is coercing me to sign some papers." What should the nurse suspect that the patient is experiencing?

Financial abuse

Which of these decreases in cognitive functioning occur in aging?

Fluid intelligence, short term recall memory, mental performance speed

Downward

Gradual and progressive deterioration in physical or mental status. Accompanied by increasing disability and symptoms. Continuous alteration in everyday life activities.

Comeback

Gradual return to an acceptable way of life.

Factors Associated with Homelessness

Having a low income, having reduced cognitive capacity, living alone, living in a community that lacks affordable housing.

Goal of Rehabilitation

Help older adults adapt to or recover from disability or an acute functional decline

The most common chronic conditions in older adults:

Hypertension, heart disease, cancer, coronary artery disease chronic obstructive pulmonary disease, cancer, diabetes, and osteoarthritis.

Stable

Illness course and symptoms controlled by treatment regimen. Person maintains everyday activities.

Declining Thermoregulation

Impairs the older persons ability to adapt to extremes in environmental temperatures. The bodies of older adults can neither conserve nor dissipate heat as efficiently. Hypo/hyperthermia occur more readily.

What are expected body changes with aging?

Increased adipose tissue, decreased hepatic blood flow, decreased glomerular filtration rate

Drug Half-Life: Older Adults

Increased in older adults. Lead to greater risk for drug toxicity and adverse drug events.

Elder Mistreatment

Intentional acts of omission or commission by a caregiver or trusted other that cause harm or serious risk of harm to a vulnerable older adult.

Crisis

Life threatening situation occurs. Emergency services are necessary.

Which cognitive function remains constant with aging?

Long term recall memory

Victims of VM

Majority are women. Have a high mortality risk that is three times higher than that of non-mistreated peers. Unlikely to report mistreatment by trusted others because of isolation, impaired cognitive or physical function, feelings of shame, guilt, or self blame, fear of reprisal, pressure from family members, fear of long term care, or cultural norms.

Older Adults: Disease Symptoms

May be atypical. Ex: Confusion may be a sign of an infection. Most common atypical illness presentations are delirium or acute change in mental status and change in functional status.

Older Adult: Diagnosing

May underreport symptoms and treat these symptoms by altering their functional status. May attribute a new symptom to aging and ignore it.

Primary Prevention

Measures such as nutritious diet, proper exercise, and immunizations that prevent the occurrence of a specific disease.

Factors that Increase the Risk of Falling

Medications (OTC ones, too), infection, electrolyte imbalance or other laboratory abnormalities, arthritis, changes in gait, balance, and mobility, neurologic impairment, decreased muscle strength and decreased visual acuity.

Older Adults: Cognitive Function

Mild decline in memory and may require more time to recall events or new information. New learning may be slower.

Men

More likely to be married and living with spouse or partner. More likely to have health insurance. Higher income after retirement. Less likely to be involved in caregiving activities. Generally have fewer chronic health conditions than women.

Women

More likely to live alone, likely to be widowed, less likely to have health insurance, more likely to live in poverty, more likely to lack formal work experience leading to lower income, more likely to rely on social security as major source of income, more likely to be caregiver of ill spouse or partner, have a higher incidence of chronic health conditions such as arthritis, hypertension, stroke and diabetes.

Ageism

Negative attitude based on age. Leads to discrimination and disparities in the care given to older adults.

Sexual Abuse

Nonconsensual sexual contact, including touching inappropriately. Forced sexual contact.

Older Adults are at Higher Risk for Accidents Due to:

Normal sensory changes, slowed reaction time, decreased thermal and pain sensitivity, changes in gait and balance, and medication effects.

Depression

Not a normal part of aging. Underrecognized problem in the older adults. Associated with females, divorced or separated marital status, low socioeconomic status, poor social support and a recent adverse and unexpected event.

Which population is at most risk for frailty?

Old-old population (85 years and older)

What is the initial phase of the chronic illness trajectory called?

Onset

Dying

Patient has to relinquish everyday life interests and activities, let go, and die peacefully. Immediate weeks, days, hours, preceding death.

Chronic Illnesses: Characteristics

Permanent impairments or deviations from normal, irreversible pathologic changes, residual disability, special rehabilitation required, need for long-term medical and/or nursing management

Factors That Put Community-Dwelling Older Adults at Risk for Domestic EM

Physical or cognitive dysfunction that leads to inability to perform ADLs, any psychiatric diagnoses, alcohol abuse and decreased social support.

Seven Tasks of People With Chronic Illness

Prevent and manage a crisis. Carry out prescribed treatment regimen. Control symptoms. Reorder time. Adjust to changes in courses of disease. Prevent social isolation. Attempt to normalize interactions with others.

Which is a major learning task for a patient experiencing chronic illness?

Prevention of a crisis

Adult Day Care

Provide social, recreational, and health related services to individuals in a safe, community-based environment. Includes daily supervision, social activities, opportunities for social interaction and ADLs for 2 major groups of adults: those who are cognitively impaired and those who have problems independently performing ADLs. Centers are regulated, and standards are met by the state.

A nurse is developing health promotion programs for older adults. Which would be the primary focus of health promotion programs at this age?

Providing services that reduce health hazards

3 Factors Appear to Precipitate Placement in Long-Term Care Facility

Rapid patient deterioration, caregiver inability to continue care because of stress and burnout and an alteration in or loss of the family support system.

Secondary Prevention

Refers to actions aimed at early detection of disease that can lead to interventions to prevent disease progression.

Which tasks will a patient with a chronic illness need to manage?

Reordering time, managing a crisis, controlling symptoms, preventing social isolation

SCALES: Nutritional Assessment of Older Adults

Sadness or mood change Cholesterol, high Albumin, low Loss or gain of weight Eating problems Shopping and food preparation problems

While caring for a patient who has undergone a surgery, the nurse finds that the patient is developing early signs of infections. Which level of care would the nurse provide to the patient?

Secondary prevention

Majority of Referrals Made to Adult Protective Services (APS) are for?

Self neglect

Which factors negatively impact the reporting rate of elder mistreatment (EM)?

Sexual orientation, immigration status, ethnic background, fear of long term care

Onset

Signs and symptoms are present. Disease diagnosed.

Physical Abuse

Slapping, striking, restraining, incorrect positioning. Oversedation with medication.

The Chronic Illness Trajectory

Theoretical model of chronic illness. Chronic illness will have many phases.

What is the number one barrier to health care for rural older adults?

Transportation

Five barrier to health care access for rural older adults:

Transportation, limited supply of health care workers and facilities, lack of quality health care, social isolation, and financial limitations.

Unstable

Unable to keep symptoms or disease course under control. Life becomes disrupted when patient works to regain stability. Hospitalization not required.

Polypharmacy

Use of multiple medications by a person who has more than one health problem

Frail Older Adult

Usually over 75 and has physical, cognitive, and/or mental conditions that may interfere with independently performing ADLs.

Acute Illness: Characteristics

Usually self-limiting, responds readily to treatment, complications infrequent, after illness, return to previous level of functioning.

Advance Directives

Written statements of a persons wishes regarding medical care. Allow individuals to more specifically direct their own care at end of life.

Example of primary prevention strategies include:

avoidance of tobacco products

A characteristic of a chronic illness is that it

results in permanent deviation from normal, is associated with many stable and unstable phases

Nursing interventions directed at health promotion in the older adult are primarily focused on:

teaching positive health behaviors