OP3 Final
Heart Transplant
(91 at CCF/year).
LITTLE SUPPORT EXISTS FOR SEXUAL EXPRESSION IN LATER LIFE!
Although sexuality is an important part of health, quality of life, and general well‐being, its discussion tends to be disregarded in the geriatric population (Nusbaum, Singh, & Pyles, 2004). In research conducted by Hyland and McGrath (2013) a majority of occupational therapists reported low levels of awareness, knowledge or confidence in addressing sexuality with their clients, and sexuality is not addressed during their everyday practice. This was due to lack of knowledge and training, fear of causing offense, and the clients' age.
Weight-bearing as tolerated (WBAT)
Amount of weight on the operated LE is left to the discretion of the client based on his/her level of comfort
Consider choices
Analyze the advantages and disadvantages of each course of action What are the reasons for or against alternative plans of care
Glaucoma
-A group of eye diseases in which the pressure inside the eye is too high for the health of the eye and causes damage to the optic nerve -Distinctive pattern of vision loss - begins by reducing vision in the mid peripheral visual field then progresses toward the center and the periphery, reducing or eliminating vision on its way -If untreated, it can leave the affected eye with only narrow tunnel vision, or without any vision -Treatable if detected early—often treated with a complex regime of eyedrops
What is Legal Blindness?
-A term the federal government uses to identify conditions that qualify an individual for government services and benefits -An individual must have a best corrected visual acuity of 20/200 or less in the better eye or -A visual field of 20o or less in the better eye -An individual who is legally blind usually has a great amount of usable visual function remaining -Individuals with visual acuity as low as 20/800 can continue to use vision to complete ADLs/IADLs -do have some usable vision, more of a low vision
What is Low Vision?
-A visual impairment that cannot be corrected by medical or surgical intervention, but allows some usable vision -The impairment is severe enough to interfere with the performance of ADLs/IADLs -It is different from blindness which involves no light perception and leaves the individual with no usable vision -can still see a little bit, just have some sort of visual impairment
Common Eye Diseases in Older Adults
-ARMD: Age-Related Macular Degeneration -Cataracts -Diabetic Retinopathy -Glaucoma
Pacemaker
-An electronic device that delivers an electrical stimulus to the heart -It is used to initiate heartbeats when the normal pacemaker of the heart (the SA node) is defective, or -In complete heartblock in which the rate of cardiac contraction and consequent cardiac output is inadequate
Conservative Treatment
-Anti-inflammatory medication -Cortisone injections -Physical Therapy
SUGGESTIONS FOR DEALING WITH DIABETES AND SEXUAL ACTIVITY
-Anxiety reduction -Consultation with an MD about possible problems associated with medication -Consultation with an MD concerning the need for a penile prosthesis—inflatable implements and flexible and semi-rigid prostheses are available if impotence is organically based -Asking partner to emphasis stimulation of areas still sensitive to touch -Communication through touch, smell and imagination to accommodate vision loss
Valve Replacement
-Aortic Valve Replacement (AVR) or Mitral Valve Replacement (MVR) -Can use tissue for replacement (lasts 12-15 years) -Mechanical replacement - must then take anticoagulants indefinitely because do not want blood to clog valve) -Possible complication - can impede the heart's ability to contract
ID visual History
-Are the vision problems new? -Are the cause of the visual problems known? -Is vision stable or does it change daily -Do the patient's eyes tire easily? With which activities? -Does the patient wear glasses? -Does the patient use magnifiers/optical aids? -Has the patient received previous vision rehab?
Visual Attention: Scanning Ability
-Ask the client to "say the numbers in the sequence that you see them; do not worry about the sequence of the numbers." -Write the numbers in the order which they are stated -Then on the line underneath the number, write the sequence in which they were stated -Draw arrows in that order and look at the scan path the patient took - is it organized and in a logical sequence? Were all numbers addressed?
Percutaneous Transluminal Coronary Angioplasty (PTCA):
-Balloon dilation (threaded through the femoral or brachial artery) to unblock coronary artery -Main complication is a CVA -Stents are inserted to maintain artery flow.
Bathing with THR/THA
-Bathtub bathing is NOT permitted -Sponge bath for the first 2 weeks after surgery or until surgical site is healed -Use a shower stall or tub seat to bathe -Sit on a sturdy chair which is 18 inches from the ground -Use a long handled sponge for bathing to avoid bending >90 degrees -Do NOT use towel bars, curtain rods, or hinged glass doors for support when moving in the bathroom -video in slide 21
INTERVENTIONS: Transfers
-Bed - avoid trapeze or any pulling - have roll and push up with elbow -Toilet, shower, tub -ADL evaluation and training: look at cardiac response -Modify activity -Assistive equipment
Predictors of sexual satisfaction
-Being sexually active -Having good mental health -Having a better functional health status -good mental health = wanting something in your life rather than it being a sort of addiction
Cardioversion or Defibrillation:
-Can be delivered internally (small patch electrodes sewn into the epicardium) or externally (large patch electrodes on the chest) -The electric current delivered interrupts the disorganized impulses, allowing the SA node to regain control of the heart
an ethical decision making model
-Collect, analyze, and interpret data -Patient/client preferences -State the dilemma -Consider the choices of action -Analyze the advantages and disadvantages of the choices -Make the decision
Assessing the Older Worker's Performance
-Complete work and intervention programs that incorporate an accurate understanding of the normal age-related processes as well as the impact of disease on functioning -Obtain current and complete job description -Perform a job analysis that looks at physical, cognitive, psychological, and environmental considerations of the job -Note the person's abilities and limitations -Experiment with job redesign to facilitate the effectiveness and employability of the older worker -Recommend reasonable accommodations
Myocardial Infarction a.k.a. "Heart Attack" (MI)
-Condition caused by occlusion of one or more of the coronary arteries -Part of the heart muscle dies -Symptoms include sweating, SOB, nausea, vomiting, heavy pressure in the chest -Acute MI: sharp, rapid onset; severe symptoms and a short course -MI = blood flow to the heart stops suddenly, can affect people in a number of ways post MI (confusion, stroke, etc.) -ask about nutrition and meal prep, health management (annual physicals, etc.)
HIP PRECAUTIONS
-Coumadin and bleeding -THA precautions: for 6-8 weeks •Do NOT flex hip more than 90 degrees •Do NOT adduct hip •Do NOT internally rotate hip •Do NOT cross legs at knee or ankle -always follow what the surgeon says -ask physician to change order for weight bearing status
Visual Problems Noted
-Decreased Occulopulsion - inability for the eye to go where it needs to go -Double Vision -Gaze Preference - always looks to one side -Headaches -Lazy Eye -Neglect -Nystagmus - constant shaking/oscillation of the eye; indicative of vestibular problems -occulopulsion = should be able to look around without moving your head -double vision = cover one lens on their glasses to help (disorientation or nausea complaints) -gaze preference = leads to visual neglect of one side
total hip arthroplasty (THA)
-Definition: Arthroplasty is the surgical formation or reformation of a joint -THA versus THR -ORIF = -open reduction internal fixation = opened up and repaired Types of prostheses -Porous-coated: allows the bone to grow into it, thus alleviating the need for cement -Non-porous: cemented
INTERVENTIONS: Psychosocial support to patient and family
-Depression (remind of improvements) -Reassurance of returning to a normal life
INTERVENTIONS: Stress management training, relaxation techniques
-Diaphragmatic breathing - use during exercise and ADLs -making a schedule that is not overwhelming is important -ID what is meaningful and what others can do for them
Factors that can affect programs
-Discrimination, oppression, and social inequities may make it difficult for minority elders to see the value of the program and that it will work for them -Language and comprehension may be an issue -Lack of financial resources may limit participation -Different cultures have different definitions of what is healthy -Gender-related roles and activities vary by group; must adapt program activities to the cultural role expectations.
patient preferences
-Does the client have decision making capacity -Has client been informed of condition and how -Have all treatment alternatives been discussed with client -Has client made a clear statement of his wishes -Is client expected to regain capacity -Is there an advanced directive
Do NOT flex hip greater than 90 degrees -What can't you do functionally?
CANNOT -lower body dressing -climbing stairs -climbing stairs -in and out of bed -in and out of a car -on and off low toilet
Do NOT adduct hip -What can't you do functionally?
CANNOT -lying in bed, positioning (adductor pillow) -side stepping
Do NOT internally rotate hip -What can't you do functionally?
CANNOT -pivoting while turning -driving (alternating between peddles)
Do NOT cross legs at knee or ankle. -What can't you do functionally?
CANNOT -put on socks seated -sitting (most people cross their legs)
CANCER AND SEXUAL ACTIVITY
Cancer often causes depression and anxiety in both the patient and the partner Many functional problems may exist -Deformity caused by surgery -Pain -Low endurance -Nausea -Changes in overall physical appearance, such as weight loss or hair loss
CARDIAC CONDITIONSAND SEXUAL ACTIVITY
Cardiac conditions often lead patients to forego engaging in sexual activity fearing that it will endanger their lives Truth--oxygen usage for sex is the same as oxygen usage for: -Climbing one or two flights of stairs -Walking rapidly at a rate of 2-2 ½ mph -Driving a car
Angina
Clinical presentation of cardiac ischemia (i.e., chest pain, vague arm neck, back pain)
Facts about TKR
Course and Prognosis -Expected life span of a TKR is 98% success at 10 years and 94 % success at 20 years Surgical Objective -Decrease pain -Provide a more stable joint -Increase ROM -Improve a client's gait pattern
Facts about THA
Course and Prognosis -Usually have about 85-97% complete relief of pain -Expected life span of a THA is 10-15 years Surgical Objective -Decrease pain -Provide a more stable joint -Increase ROM -Improve a client's gait pattern -Decrease stress from the back AND knees -ON EXAM -analgesic gait = painful gait pattern
SUGGESTIONS FOR DEALING WITH ARTHRITIS AND SEXUAL ACTIVITY
-Exercise program to increase joint mobility -Use of heat (hot shower, hot-water bottle, heating pad) on joints prior to sexual activity -Taking pain medication prior to sexual activity -Avoidance of positions that place prolonged pressure on the involved joints -Communication with partner about positioning limitations **Alleviates partner's fear of causing pain **Alleviates patient's fear of being hurt -Experimentation with adaptive positions and/or alternatives to intercourse (i.e. masturbation or oral sex) -Setting aside a rest period before engaging in sexual activity to prevent fatigue (a hallmark of rheumatoid arthritis)
SUGGESTIONS FOR DEALING WITH CVA AND SEXUAL ACTIVITY
-Experimentation with comfortable positions -Use of a vibrator if hands are weak and/or uncoordinated (vibrator may be strapped to the hand) -Emphasizing stimulation of areas that are still sensitive to touch -When vision is affected: **Exploration through touch and smell **If vision is impaired on one side, partner should remain on the "seeing" side -Use of non-verbal communication (i.e.sharing fantasies in writing)
INTERVENTIONS: Progressive activity and exercise
-Graded activity (keep in mind cardiac stress) -Conditioning -UE AROM - stretching -UE strengthening (not strength testing though - can assess through observation) -start low! (grooming, bed bath, etc.) -conditioning: grading the activity, adding a little bit more every day -PROM can help too (watch UE) -strengthening: tested through observation (can they push off the bed to stand, hold a full coffee mug, etc.) -do not use a trapeze for transfers -roll to the side and push up for bed mobility -shower: safe, energy conservation (colder temperatures, etc.), -cooking: sliding stuff across the counter, commonly used items in reach, seated, etc.
Confrontation
-Have patient cover one eye and say "While looking at my nose, tell me how many fingers I have up" -Use only 2, 3, or 5 fingers. Do not use 1 or 4 fingers -Repeat this in all four quadrants -This test is only about 50% accurate
Health
-Health - "complete state of physical, mental & social well-being & not just the absence of disease or infirmity" (WHO, 1947, p.29) -"Absence of illness, but not necessarily disability; balance of physical, mental & social well-being attained through socially valued & individually meaningful occupation" (Wilcock, 1998, p. 110) -Health Promotion - "The process of enabling people to increase control over and to improve their health" (WHO, 1986, p.iii) -Wellness - way of life involving actions, values & attitudes that support or improve health & quality of life (Brownson & Scaffa, 2001) -looking at all things that are included in our QoL (values, beliefs, etc.)
Smooth Pursuits
-Hold a pen 18" away from the client's face and trace the pattern of a letter "A" or a letter "H" -Perform slowly, then increase the speed -Watch to see if the patient loses fixation on the pen or if the patient can maintain attention
Convergence
-Hold pen at midline and come towards the face -At the breakpoint, the dominant eye will continue following and the non-dominant eye will deviate out - this is normal
Saccades
-Hold two objects 12" apart approximately 16" away from the face -Instruct the patient to look from one to the other quickly without moving their head, only their eyes - do this centrally and in each quadrant -The therapist is looking for speed and coordination of yoked eye movement -This skill is important for tasks such as reading and driving -saccades important for reading (scanning with eyes only)
General Considerations When Working With Clients With Low Vision
-Identify yourself immediately on entering the room and speak directly to the patient in a normal tone, not louder than usual -Explain what you are going to do before you begin, then proceed in an orderly, sequential manner -If you must leave the client alone, be sure that he or she is oriented to the surroundings, can make physical contact with the environment and knows that you are leaving -Avoid overprotecting the client. Let the client do as much as possible independently and experiment with his or her own techniques in completing a task; intervene if these techniques present safety hazards -Use straight-forward words to build a clear mental image or "word picture" of the process to apply to the task -Describe materials, devices, and equipment to use; how to use them; and the results you intend before you begin -Be specific in directions. Say "let me show you" and guide the patient's hand gently through a task -Encourage patients to rely on other associated senses in determining choices and actions -do as much as they can to become independent -building a picture from words -1-2 step commands -hand-over-hand technique if needed
Post hip surgery
-Immediately after surgery- pain relief Tested for deep vein thrombosis (DVT) -All patients are given coumadin -If a clot is found in the patient given IV heparin and bedrest for 24 hours -Early motion is encouraged- ankle pumps -Isometric exercises -Dangling their feet at the bedside Day 1 -Standing on Day 2 with assistance -Ambulation begins on a walker
Post knee replacement surgery
-Immediately after surgery- pain relief -Short-term outlook is excellent -Usually FWB and can stand immediately -Exercise POD 1 -CPM Machine--want knee flexion -Often discharged home in less than one week--important for OT to do ADL training Contact physician or nurse immediately: -Increased edema in operated leg -Severe pain or drainage from the incision line on operated leg -Tenderness in the thigh or calf of the operated leg -A persistent or daily fever
PROMOTING HEALTHY SEXUAL EXPRESSION IN LONG-TERM CARE FACILITIES
-Include sexual history in the ADL assessment -Instituting a patient education program outlining sexual activity related to medical problems and the older adult -Listening for verbal and nonverbal cues of sexual concerns -Avoiding personal shyness about the subject—although sex is a personal and private matter, it does not have to be taboo -Emphasizing what is left rather than what has been lost -Recommending books to patients, having them available in the facility, and making provisions for books to be read to those patients unable to read -Redirecting inappropriate sexual expression to more healthy outlets rather than punishing the patient
positive effects of older adult sexuality
-Increased Relaxation -Decreased Pain Sensitivity -improved Cardiovascular Health -Lower Levels of Depression -Increased Self-Esteem -Better Relationship Satisfaction
PROBLEMS WITH SEXUAL EXPRESSION INLONG-TERM CARE FACILITIES
-Insuring privacy for the roommate of a sexually active resident in a semiprivate room -Allowing privacy without locking doors -Protecting patients who don't want sexual activity from those who do -Allowing visitors to spend the night -Providing larger beds for residents -Liability issues (i.e. falling out of bed) -Dealing with cognitively impaired residents -Should the wishes of the patient or those of the family come first?
Kitchen Safety
-Large-print letters can be written on labels to identify food items -Different colored labels can be used to distinguish amongst categories of foods -Mark the over or burner dial at the point the resident uses most (i.e. 3500) with a Hi-Mark. -Use plastic trays or cutting boards of contrasting colors to prepare foods (i.e. cut apple on a white cutting board) -Color-coded or high contrast measuring cups -Use of long oven mitts -Measure spices in the hand first to avoid over pouring (see better in hand than on food)
Bathroom Safety
-Place a contrasting-color, non-skid, textured bathmat in the tub or shower to prevent falls, and a cue for judging the depth of the water -Clearly mark the hot and cold water controls -Set hot water to a medium range temperature to reduce the danger of scalding -Keep frequently used bathing products in the tub/shower within easy reaching distance. If necessary place tactile markings on the products for proper use. -Place lighting low in bathrooms, and on either side of the mirror, if possible
Prevention
-Primary - strategies to help older adults avoid the onset of negative health conditions, diseases or injury -Secondary - early detection and treatment to prevent or disrupt a disabling process -Tertiary - treatment and services to arrest progression of a condition, prevent further disability and promote social opportunity
ARMD: Age-Related Macular Degeneration
-Progressive degeneration of the cells of the macula and the fovea in the center area of the retina -Causes central vision loss exclusively and does not affect peripheral vision -Leaves the individual with a great deal of vision and never causes complete blindness
SEXUAL ACTIVITY IN LONG-TERM CARE FACILITIES
-Research indicates that 50% of older adults in LTC facilities want sexual activity -ADL assessments rarely include information about sexuality -LTC residents often have no option for the privacy necessary for conjugal visits, masturbation, or even kissing or holding hands
Venues for wellness programs
-Residential and Assisted Living Facilities -Senior Center Programs -Adult Education -Public Libraries -Hospital/Agency-Based Education -Religious Affiliations
sexual attitudes
-Sex remains an important aspect of life for most older adults -Those with more sexual activity report it becomes more rewarding over the years -Focus more on intimacy vs. coitus -Frequency and quality of sexual activity in early adulthood correlate with the frequency of sexual activity in late adulthood
Toileting with THA/THR
-Sit on an elevated toilet seat -Support self with grab bars or a nearby sink or vanity when transferring on and off the toilet -Bend the hip and knee on non-operated side and keep operated leg extended forward -3 in 1 Commode is an option video on slide 22
Characteristics of wellness programs
-Stress that no one is too old to change -Offer dramatic information such as case studies -Promote immediate benefits of the activity -Establish link between target behavior & specific health problem -Are specific about actions required -Provide support groups and opportunity to practice behaviors -Involve personal physician whenever possible -Includes older adults in the planning process -Reflect -ex: before and after pictures, decrease in health issues, etc.
The surgery of the hip
-Takes about 2 hours -Spinal anesthesia or general -Lateral surgical approach -Femoral head is disarticulated and resected -Femoral canal is reamed to accommodate the prosthesis -Trial prosthesis is inserted -PROM is performed by the surgeon to ensure adequate ROM and stability of the new hip joint. -May receive unilateral THA or bilateral THA. videos on slide 6
TKR Surgery
-Takes less than two hours -Spinal anesthesia or general -Anterior surgical approach -Only the surface of the joint is removed -The arthritic ends are shaved off and replaced with new metal and plastic surfaces -Potential problems included infection and DVT
Etiology of the hip
-The hip is a large weight bearing joint nChronic synovitis in that area results in increased intra-articular pressure, pain and loss of cartilage -Synovium gets trapped between joint surfaces increasing wear and decreasing range of motion -In severe RA the head of the femur may protrude through the softened acetabulum. -hip is the largest weight bearing joint in the body
etiology of the knee
-The knee joint functions like a hinge joint at the junction of the femur and the tibia -The ends of the bones are covered with a thick, white cartilage--you are only given one covering of this in your lifetime -When the cartilage is damaged or worn away, the underlying bones rub together, producing pain and inflammation
what is wellness?
-The term Wellness was coined by a physician named Halbert L. Dunn, who published a small booklet entitled "High Level Wellness" in 1961 -Dr. Dunn saw wellness as a lifestyle approach for pursuing elevated states of physical and psychological well-being -His philosophy was multidimensional, centering on personal responsibility and environmental awareness
Arteriosclerosis
A form of atherosclerosis - hardening of the small arteries (arterioles)
Distance vision
Determined by the Snellen Chart Determined by the eye specialist Can ask patient what they have trouble seeing (i.e. unable to read street signs)
ADA's Role
ADA mandates that reasonable accommodations must be made for older adult employees -Redesigning the workstation: adapted seating, job station redesign, injury prevention, and ergonomic principles -Consider part-time work (may be a reasonable accommodation)
Formats for Programming
Active participation -More desirable than lecture formats -Involve participants in the process using life experience and group discussions Familiarity -Use former skills and build upon past knowledge, skills, and abilities Organization -Older adults have difficulty organizing information -Trainers should organize the material being presented to help with retention and comprehension Time -Slower presentation of training material -Provide longer time to study and for tests -Self-paced learning is optimal Strategies to Learn -Older adults should participate in determining the training content, method, goals, and evaluation -Positive environment will increase self-confidence, risk taking, and participation
Dressing with THA/THR
Dress surgical leg first, undress last Use the recommended equipment -Reacher -Sock aid -Long shoe horn -Dressing stick -Elastic shoelaces Avoid reaching past knees Do not cross legs Do not bring surgical leg up toward chest -video on slide 19
WHAT IS THE SOLUTION?
EDUCATION "Education is needed to improve perceived competence and confidence in addressing sexuality with older adults" (McGrath & Lynch, 2014, p. 651). "Education and training for occupational therapists should focus on changing attitudes towards sexuality and people with disabilities as well as providing information on occupational therapy interventions in this area" (Hyland & McGrath, 2013, p. 73)
ARTHRITIS AND SEXUAL ACTIVITY
Evidence exists indicating that regular sexual activity helps rheumatoid arthritis -Adrenal gland production of cortisone -Sexual activity tends to lessen stress
OT Intervention
Focus precautions in daily living skills The therapist reviews the proper way for the patient to get into and out of bed -Sleep on a firm mattress at least 18 inches -Sit on bed and scoot backward until calves are resting on mattress -Keep knees, shoulders, and hips in alignment -Sleep on back or on either side -Position pillow between legs to prevent hips from rotating inward -you can sleep positioned on your surgical side -videos on slide 17
Near vision
Give choices of various sizes of the letter E on a sheet of paper to determine what the client can see Translate this into a font size
Atherosclerosis
Hardening of the arteries
Hypertension (HTN)
High blood pressure -120 (systolic-force against arterial walls as a result of ventricular contraction)/80(diastolic-force against arterial walls as a result of ventricular relaxation) = normal -160/90 to 200/110 is high -Increases with age, smoking, atherosclerosis -Male > Female -ensure they are taking their blood pressure medication (medication management)
Congestive Heart Failure (CHF)
Inability of the left side of the heart to maintain cardiac output at rest -CHF: LE swelling and fluid, fluid can build around lungs and lead to death
Endocarditis:
Inflammation of the lining membrane of the heart -Immunological reaction -Needs to be treated quickly (deadly)
Pericarditis
Inflammation of the sac that encloses the heart (pericardium)
Myocardial Ischemia
Insufficient blood supply to the myocardium (due to CAD)
Ethics and Patient's with Dementia
Issues are pronounced with this population because: •The nature of the disease leads to gradual loss of self in an adult who was previously able to be responsible and independent •The person's rights often come into conflict with those of others as the disease progresses •Behavior is not stable over time; constant readjustment is required, unpredictable •Individuals often cannot communicate their needs/wishes
Hypotension
Low blood pressure -Systolic pressure (top number) is less than 90 -Results in dizziness
Demographics
MALES Aged 60 to 64, the survey found that approximately 85% had a sexual partner in the past 12 months Aged 80-84, 45% had a sexual partner in the past 12 months FEMALES Aged 60 to 64, the survey found that approximately 55% had a sexual partner in the past 12 months Aged 80-84, 5% had a sexual partner in the past 12 months
OLDER ADULT SEXUAL HEALTH AND SEXUAL ACTIIVITY
VVVV Objectives ¡Understand why sexual health and sexual activity is important in the older adult population ¡Learn why education in this area is necessary for occupational therapy practitioners ¡Discuss what occurs physically during the normal aging process ¡Explore the role of the occupational therapist providing intervention regarding sexual health and sexual activity ¡Review techniques for increased participation in sexual activity ¡Develop intervention strategies in the area of sexual activity for certain disease processes ¡Examine how sexual activity is addressed in long-term care facilities
Low Vision: A Closer Look
VVVV Objectives -Define the Components of Vision -Define Low Vision and Legal Blindness -Learn the Common Eye Diseases in Older Adults -Learn How to Conduct a Low Vision Evaluation -Discuss Techniques in Treating Individuals with Low Vision -Journal Club Presentation
Ethics and Public Policy
VVVVV
ACTIVITY AND CARDIAC STRESS
oHeart rate and BP response are higher with arms at chest level or above: do not do overhead work, start at chest height. oCardiac response is increased with isometric activity - e.g., grip strength or hand putty - AVOID oSmaller muscles and rapid movement of small muscles are more stressful on the heart than larger movements of large muscle groups oMetabolic Equivalency or MET level is one way to quantify energy cost of activities. o1 MET=oxygen consumed per minute per unit of body mass at rest. Energy cost of activities is expressed in multiples of this MET unit. oSEE MET TABLE in Pedretti text and ADL progression -arms above your head raises BP, arms down lowers it -sex is actually fairly low MET (depends on how aggressive)
IF ANY OF THESE SYMPTOMS ARISE
oSTOP activity oHave person sit down or lie down with head elevated oIf symptoms continue -Call 911 if in person's home -Call nurse if in a facility
visual field consists of
central, peripheral, and confrontational vision
Interpretation
correctly interpreting the information the brain receives from the eyes -interpretation = what you see and what it means
Although we usually think of acuity as the most important element,
deficits in the other four components (visual field, contrast discrimination, glare modification, and interpretation) also cause severe visual impairment
vision therapy resources
https://www.youtube.com/watch?v=fbx6Q6mCpMY https://www.youtube.com/watch?v=kD2n9lBy6JY Use of Assistive Technologies commercial for continuing ed course from AOTA on Low vision and older adults https://myaota.aota.org/shop_aota/product/OL37
SEXUAL POSITIONING
slides 20 - 28
AREAS OF PAIN DUE TO ANGINA
more on the left side
visual acuity consists of
near and distance vision Sources for pocket size Snellen Charts or alternatives for persons with communication issues. https://www.allaboutvision.com/eye-test/snellen-chart.pdf https://www.bing.com/images/search?q=alternatives+for+snellen+eye+chart&id=DD5D17C79AC3EA4F257229FD001EADF4FD529DAD&FORM=IQFRBA You can do a matching exercise for non-verbal people by printing very large cards of the icons used in the alternative charts.
SIGNS OF CARDIAC DYSFUNCTION
oANGINA oDYSPNEA oFATIGUE oEXCESSIVE PERSPIRATION -discomfort, chest pain, vomiting, SOB, etc.
PRECAUTIONS
oAVOID ISOMETRIC ACTIVITY: No manual muscle test, no isometrics with ADLs oAVOID STRESS ON CHEST INCISION: No shoulder flexion or abduction >90o oMAINTIAN GOOD BREATHING: Avoid Valsalva Maneuver oALWAYS BE AWARE OF SIGNS/SYMPTOMS OF CARDIAC STRESS oSOME CLIENTS WILL HAVE NEUROLOGICAL INVOLVEMENT -Valsalva = hold your breath and tensing
path of blood flow through the heart
oDeoxygenated blood enters the right atrium via the superior vena cava (from head and UEs), inferior vena cava (from trunk and LEs) and coronary sinus (from vessels supplying the wall of the heart oFlow continues from the right atrium through the tricuspid valve to the right ventricle to the pulmonary trunk oThe pulmonary trunk divides into the right and left pulmonary artery each which carry blood to one lung oIn the lungs, the blood releases carbon dioxide and takes on oxygen - this blood is called oxygenated blood oThe oxygenated blood returns to the heart via four pulmonary veins that empty into the left atrium oFlow continues from the left atrium through the bicuspid valve to the left ventricle to the aorta oFrom the aorta the blood flows throughout systemic circulation -not always the main reason you are seeing them, but it is usually a comorbidity with a new/current condition
Central Vision
what is the patient's vision for objects directly in front of them
Peripheral Vision
what is the patient's vision for objects to either side of the head
Beneficence
•"do good" for clients under care •provide services in a fair and equitable manner •strive to ensure that fees are fair and reasonable and commensurate with services performed •make every effort to advocate for recipients to obtain needed services
Tenets of Hospice Care
•24-hour care as needed; on-call nurses •7-day-a-week admissions •Quality of life care •Pain and symptom management -Pain from disease -Pain from intervention (i.e. chemo or radiation) -Pain from immobility -Pain from loss •Provides medication, medical supplies and equipment •Residential and inpatient care •Respite •Bereavement services (typically up to one year following death) -i.e., medical supplies, medications, services, etc. -up to a year = helps you get through milestones (i.e., first birthday without them, Christmas, anniversary, etc.), able to cope a little better after one year
Ethical Dilemma
•A difficult problem seemingly incapable of a satisfactory solution •A situation involving choice between equally unsatisfactory alternatives •Moral claims conflict with each other
Veracity
•Accurate information about occupational therapy services •Accurately represent their credentials, qualifications, education, experience, training, and competence •Disclose any professional, personal, financial, business, or volunteer affiliations that may pose a conflict of interest
Duties
•Achieve and continually maintain high standards of competence •Hold the appropriate credentials •Critically examine and keep current with emerging knowledge relevant to their practice •Provide appropriate supervision •Refer or consult with other providers whenever a referral or consultation would be helpful to the care of the recipient
What is hospice?
•An individualized program that provides physical, emotional, spiritual and psychosocial care for patients and families in the last phases of life •Care is provided predominately in the home or residential care facilities •It provides support and care for patients so that they may live as fully and comfortably as possible •Utilizes an interdisciplinary group to provide care which is comprised of MDs, nurses, therapists, social workers, chaplains, aides and volunteers •Recognizes dying as a part of the normal process of living and focuses on maintaining the quality of remaining life
Iron Deficiency
•Anemia—fatigue, exercise intolerance
Criteria for Hospice Eligibility
•Any diagnosis •Medical prognosis of £ 6 months to live •MD certification of terminal illness •Only palliative care, no curative intervention •Family and client must be aware of diagnosis and understand difference between curative and palliative care •Patient agrees with goals of care and desire services •Can change their minds and return to curative care
Aging and death
•Beginning at age 40, individuals measure life in by how many years remain, rather than how many years have passed •Fear of death can be intense but diminishes as people age •Increased incidence of multiple losses--spouse, siblings, and close friends •Generally, older adults die of chronic diseases •Involves a slow decline •Issues of loss of control over one's selfand future •Multiple physical and mental changes -diminishes because they have more experiences with others in their life dying -loss of control (i.e., driving cessation, loss of capacity to make choices for themselves, etc.)
Cardiac Rehab
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Nutrition and Older Adults
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THA-THR
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TKR
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Wellness and Prevention Programs
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END OF LIFE
VVVV "A season is set for everything, a time for every experience under heaven: A time for being born and a time for dying." Ecclesiastes 3:1-2 "What man shall live and not see death?" Psalm 89:48
Ethics
•Beneficence •Nonmaleficence •Autonomy •Duties •Justice •Veracity •Fidelity -20 CEU hours after graduation and licenser -must have one hour of those be ethics
Just Before Death
•Client becomes unwilling to eat or drink •Endorphins are released leading to feelings of well-being •Clients become drowsy/unarousable •Still able to hear and understand •Symptoms of agitation, restlessness, moaning appear as client is on the verge of death
Interventions for Clients with Malnutrition: Those with depressive symptoms are more likely to become malnourished because of loss of appetite and weight loss
•Collaborate with clients and develop meaningful leisure activity kits to increase occupational participation that supports enjoyment and quality of life •Advocate for social opportunities •Help clients explore community activities to enhance a sense of belonging -look for meaningful engagement (focus on depression first, then the nutritional aspect)
Justice
•Comply with laws and Association policies guiding the profession •Remain abreast of revisions in those laws and Association policies
Consequences of Undernourishment
•Decreased bone mineral density •Sarcopenia: the loss of muscle mass 2) Sarcopenia is accelerated in those with poor nutrition Less muscle leads to muscle weakness, poor activity tolerance and increased fall risk
control over life and death
•Desire to die with dignity •Documents of control -DNR -Health care proxies -Living Wills -Vary between states •People want things settled with family, to die in comfort and without pain •Those surveyed reported it would be important to: -Write a life history -Provide advanced care planning including living wills/power of attorney -Provide opportunity for spiritual connection at end of life -proxies = power of attorney for general life matters and another for health care matters (make sure they know what your decisions are)
TKR Precautions
•Do NOT kneel on operated leg •Do NOT twist operated leg •Do NOT squat
Nutritional Requirements in Older Adults
•Do not require the standard 2,000 calorie diet Daily diet for a healthy older adult •15-20% Protein •30% Fat •50-60% Carbohydrates •Prevent constipation 1)Slower metabolism and less active lifestyle 2)Total calories 3)Eat enough fiber and drink enough fluids—reminders because thirst declines with age; six to seven 8 oz. glasses of fluid per day ● ● -carbs in the form of fiber (constipation common)
the older worker
Primary reasons the older worker is out of work: -Voluntary or mandatory retirement -Layoff or discouragement -Infirmity or disability -Technological advances -Problems of reentry -Career switches -Poor qualifications -poor qualifications ex: didn't go to college to keep family afloat or couldn't afford college -technology can be intimidating for older adults
Hypoxia
Reduced oxygen supply
Ischemia
Reduction of blood flow (causes hypoxia) -low blood supply and O2 supply can lead to cognitive issues
CVA and sexual activity
Research indicates that a majority of CVA survivors maintain consistent levels of sexual desire and believe that sexual function is important, but most will experience sexual dysfunction following a CVA -Dysfunction is related to fear of sexual activity causing another CVA -Highly unlikely that sexual exertion will result in another CVA
Characteristics of well-being
Research suggests that the "wellest of the well" possessed the following qualities: -High self-esteem and a positive outlook -Sense of purpose -Strong sense of personal responsibility -Good sense of humor and plenty of fun in life -Concern for others and a respect for the environment -Conscious commitment to personal excellence -Sense of balance and an integrated lifestyle -Freedom from addictive behaviors of a negative or health-inhibiting nature -Capacity to cope with whatever life presents and to continue to learn -Grounded in reality -Highly conditioned and physically fit -Capacity to love and an ability to nurture -Capacity to manage life demands and communicate effectively -purpose and responsibility à a feeling of success and productivity (can be as little as caring for grandchildren, going to a social group, etc.) -make the best of things -ability to care for others and to be cared for
scan board
SLIDE 26 -read the numbers left to right (6,5,7,3,1,0,2,4,9,8) (i.e., if they do not say the numbers on one side, that could should a loss of that area of vision)
TECHNIQUES FOR INCREASED PARTICIPATION IN SEXUAL ACTIVITY
Sexual positions -Should not require support of the body on isometrically contracted UE muscles -Should not put pressure on joints or areas of the body prone to pain or muscle strain -Oral-genital or digital stimulation -Masturbation -Use of vibrators -Massage -Use of water-soluble lubricants (K-Y Jelly) during sexual intercourse or masturbation -Hugging, kissing, stroking or talking
OTPF and Sexual Activity
The Occupational Therapy Practice Framework (OTPF): Domain and Process 4th Edition (AOTA, 2020, p. S19) defines sexual activity as "engaging in the broad possibilities for sexual expression and experiences with self or others (e.g., hugging, kissing, foreplay, masturbation, oral sex, intercourse)"
Dyspnea
Difficulty breathing, may indicate left ventricular failure -DOE=Dyspnea on exertion -SOB=Short of breath -helpful terms for documentation
Meal Prep Techniques to Minimize Fatigue
•Plan ahead •Pace yourself •Have a place to sit in the cooking area if a rest break is needed •Sit while dicing, mixing, etc. •Use kitchen gadgets that can save energy •Keep the kitchen cool •Allow dishes to air dry •Prepare multiple meals at once to use later 1)Have all ingredients and utensils out before beginning a cooking task 2)Rest while food is baking or items are boiling 3)Food chopper, blender, food processor 4)Excessive heat can lead to decreased activity tolerance; prepare food outside of kitchen -energy conservation and work simplification
Folate Deficiency
•Poor cognition •Anemia •Increased risk of vascular disease •Increased risk of depression •Increased risk of age-related macular degeneration
Vitamin B12 Deficiency
•Poor cognition •Loss of balance •Increased risk of vascular disease •Increased risk of depression •Increased age-related macular degeneration
recommendations for family/provider
•Sit close and at eye level •Touch the person •Let dying individual set the pace for conversation •Don't contradict when client says he is going to die •Enable decision-making •Encourage happy reminiscences •Never pass up the opportunity to express love and say goodbye
Nonmalficence
•Take reasonable precautions to avoid imposing or inflicting harm upon the recipient of services •Maintain relationships that do not exploit the recipient of services •Avoid relationships or activities that interfere with professional judgment and objectivity
Euthanasia
•The act of death carried out painlessly to end suffering of another individual •Assisted suicide -MD writes a prescription for life-ending medication and client takes dose him/herself -Only Oregon permits assisted suicide •Advocacy groups believe that quality of life is personal and can only be judged by the individual who is suffering
Autonomy
•The right of self determination, independence and freedom •respect client's rights to make decisions about and for them, even if the HCP does not agree. •HCP may interfere only when believe client lacks capacity, or is being coerced.
Rights of Patients with Dementia
•The right to a meaningful life in spite ofdisability •Quality of life for both person and caregiver •Autonomy: right to independence vs. appropriate dependency; right to choose for oneself •Knowing the wishes of the patient •Decision making process: who and how decisions are conveyed
FIdelity
•Treat colleagues and other professionals with fairness, discretion, and integrity •Preserve, respect, and safeguard confidential information about colleagues and staff •Accurately represent the qualifications, views, contributions, and findings of colleagues
Grocery Shopping Interventions
•Use the grocery cart to steady self •Use a motorized scooter with a basket •Ask for assistance from an employee to load heavy bags into the car •Home delivery service
Death
•What is Death? -The end of life -Part of the life cycle •More timely among older adults •Brain dead -Cessation of brain functioning -more common experience when working with older adults -life support = whatever that person may need to keep them alive (i.e., nutritional supplements, respirator, etc.)
Public Policy
•What public policies effect OT? •Why is it important that OTs remain knowledgeable about current and changing policies? •How can OTs effect future policy?
Websites with Public Policy Issues Relevant to the Older Adult
•www.aarp.org/research •www.aarp.org/ageline/home.html •www.aarp.org •www.whitehouse.gov/infocus/medicare/ •www.policyalmanac.org/health/medicare.html •www.medicare.commission.gov/medicare/index.html •www.medicare.gov •www.cms.hhs.gov/default.asp?from
SUGGESTIONS FOR DEALING WITH CARDIAC CONDITIONS AND SEXUAL ACTIVITY
-Learning that the likelihood of a "coital coronary" is very small -Taking a less active role to reduce performance anxiety -Masturbation (cardiac cost is less than that of intercourse) -Use of energy-conserving, non-weight-bearing sexual positions (i.e. sitting or side lying) -Avoidance of sexual activity when anxious or fatigued -Avoidance of sexual activity in extremely hot, humid or cold settings to eliminate the energy expenditure involved in maintaining body temperature -Improvement of overall fitness/endurance through a medically supervised conditioning program -Consultation with MD if medication affects libido, lubrication or erectile capacity - MEDICATION SHOULD NOT BE DISCONTINUED WITHOUT MEDICAL CONSULATION!
Physical Environment
-Leave furniture and personal items in the same place and location once they have been positioned safely -Keep the largest pieces of furniture against walls and out of the path of ambulation. Keep the footpath as clear and free of obstacles are possible -Check furniture for sharp edges/corners and caution the patient -Keep all doors either completely opened or completely closed. Doors can be a major hazard when left ajar. -Consider purchasing a portable telephone that the patient can take from room to room to enable him or her to answer the telephone without rushing for it -Mark edges of all steps and ramps with high-contrast paint or tape Paint doors and door frames in bright, solid colors that contrast with that of the door. Paint or purchase doorknobs or handles in a color that contrasts with the color of the door. -This allows individuals to locate doors quickly in an emergency, and to identify whether or not the door is opened or closed -In hallways, make sure lighting is uniform throughout
Coronary Artery Bypass Graft (CABG)
-Main purpose is to increase blood flow to the heart and to decrease the risk of further cardiac problems -Blood vessel from another part of the body (usually the saphenous vein from the leg or the internal mammary artery from the chest) is used to bypass the blocked region of the coronary artery -Complications include CVA, infections of the wound, weaning from a respirator Post-Op Course o1-2 days CICU (Cardiac Intensive Care Unit) o2-3 days walking o5-7 days home Resuming activities oNo lifting more than 5 lbs. during the first 6 weeks oSexual relations after a few weeks oDriving in 6 weeks nProcedure usually lasts about ten years
WHY IS THERE A DIFFERENCE BETWEEN MEN AND WOMEN?
-More difficult for women to find a sexual partner -Women are more likely to survive their husbands -For every four unmarried women over the age of 65, there is only one unmarried man in the same age range -Older men tend to remarry more frequently than older women Baby Boomers -Generational difference -Are more likely to have a sexual relationship if not married
Slowing of the sexual response in females
-Most sexual changes in women are associated with a decline in female hormones -Vaginal lubrication takes longer -Reduction in the expansion of the vaginal barrel in length and width -Lining of the vagina begins to thin and becomes easily irritated -Bladder and urethra become irritated during intercourse -Vaginal secretions become less acid, increasing the possibility of vaginal infection -Clitoral size decreases and the clitoral hood atrophies -Orgasmic phase is shorter, but the capability for multiple orgasm remains
Mitral Valve Repair
-Must be done when a mitral valve leaks - the valve does not close all the way and causes regurgitation -Causes: left ventricle is dilation; CAD damages valve muscles; intrinsic abnormality.
Low vision and OT
-Occupational therapy joined the list of providers of low vision rehabilitation services in 1991 after the Health Care Finance Administration (HCFA) decided that a visual impairment is a physical impairment for the purposes of Medicare coverage -To be reimbursed by Medicare for occupational therapy services in the state of Ohio, the referral for low vision must come from an MD -Occupational therapists provide treatment intervention to increase independent functioning and safety within the home, community and workplace.
Diabetes and Sexual Activity
-One of the few diseases that can cause chronic impotence -In women, a complete absence of orgasmic response may occur -Orgasmic dysfunction may develop gradually and is directly correlated with the duration of diabetes
Diabetic Retinopathy
-Only common eye disease that can cause varying patterns of vision loss because it affects the blood vessels that support the entire retina -Usually have scattered spotty areas of vision loss called scotomas causing a "Swiss Cheese" pattern of vision loss -This disease can lead to total blindness -The better the control of the blood glucose level, the lower the risk of developing diabetic retinopathy
Cataracts
-Opacification or "cloudiness" of the lens of the eye -Dulls colors and blurs vision -Develop slowly and early-stage cataracts do not limit function -Most common form affects distance vision before it affects near vision -Patient can undergo surgery to remove the natural lens and replace it with a synthetic lens called an intraocular lens
car transfer with THR/THA
-Park several feet from the curb -Make sure the front seat is pushed all the way back -Stand on the street level with your back to the car -Lower self into seated position -Swing both legs into the car with someone assisting -Reverse process to get out of the car -Do not step into the car -Do not sit in the car for extended trips (every 40 to 45 minutes you should take a standing break) -Do not drive a car until you discuss this with your physician -videos on slide 24
sexual relations with THR/THA
-Patients are encouraged to ask their physician, nurse clinician or therapist if they have questions regarding sexual relations -Pictures of safe positions are available and can be reviewed by the therapist
slowing of the sexual response in males
-Penile contractions during orgasm may be fewer in number -Loss of erection after ejaculation and testicular descent occur rapidly More likely to experience erectile dysfunction -Physical factors: vascular disease, HTN, diabetes, neurological disorders, physical injuries -Psychological/environmental factors: lack of exercise, sleep deprivation, smoking, abstinence -Prescription drugs -Penile erection takes more time and may not be as hard as before; direct penile stimulation may be required -Testicles elevate later and to a lesser degree Ejaculatory control increases -Ejaculation may take place every third sexual episode -Less preoccupation with orgasm -Refractory period between ejaculations is longer Ejaculation is less powerful, and orgasm is often less intense
Lighting
-To increase the amount of lighting on a task, move the light closer, or increase the wattage of the light -Substitute cool, white fluorescent fixtures with incandescent or warm-glow fluorescent tubes - incandescent light is always favorable to fluorescent light -Position task lighting so that the light source focuses downward directly over the object rather than diverted or aimed at the ceiling -Reduce glare. Access to natural light is optimal for health, but the glare from direct sunlight can virtually disable most patients with low vision -light directly over the person or over the object they are working with (i.e., desk light) -natural light is great, but the glare can be extremely difficult (use of wrap around sunglasses to help)
Partial weight bearing (PWB)
-Typically refers to bearing 50% of body weight on operated LE -Restriction can be measure objectively with commercially available devices, but is frequently estimated by the OTR/L and client
SUGGESTIONS FOR DEALING WITH CANCER AND SEXUAL ACTIVITY
-Use of non-weight-bearing positions to avoid fatigue -Mutual masturbation or oral sex -Timing sexual activity around a pain-medication schedule so that pain is not a limiting factor -Incorporation of massage or deep breathing into foreplay to help both partners relax and to relieve pain -If breathing is difficult when lying down, having sex in a sitting position, propped up on a pillow, or in a large comfortable chair -Taking a less active role
Home management with THA/THR
-Use reachers to pick up items from the floor or from shelves that are out of reach -Slide items across counter tops as opposed to carrying them -Sit on a high stool when performing countertop tasks -Do NOT scrub floors on your hands and knees -Do NOT squat to pick items up from low surfaces -Do NOT carry items while using a walker or crutches -Do NOT leave throw rugs on the floor.
Toe-touch weight-bearing (TTWB)
-Weight on operated LE is limited to TOE ONLY making contact with floor, mainly for balance -Majority of weight bearing is through the non-operative LE and both Ues on the ambulation device
Collect, Analyze, and Interpret Data
-What is the current medical status -What is the diagnosis? Prognosis? -What treatments are possible -What is the probable life expectancy and what will be the general condition if the treatment is given -What are the risks and side effects of treatment -What is the probability the treatment will be of benefit -What are the benefits
INTERVENTIONS: Patient education
-Work simplification and energy conservation -Techniques to resume daily living to modify lifestyle: oPrioritize, delegate and pace oRecognize signs of fatigue and SOB oAvoid stressful situations or extremes of emotion - anger, frustration
Role of the OT
-Your role as an occupational therapist is to assist the older adult with learning to function at their optimal level of function despite physical setbacks -It is important to be sensitive to the social and emotional aspects, as well as the physical aspects, implications of treatment, disease and injury
Kubler-Ross' Six Stages of Death
1. Denial -Individual is filled with shock and disbelief -Denies impending death 2. Anger -Individual expresses resentment towards others and external events 3. Bargaining - Individual asks for an extension in time 4. Organizing/Completing Unfinished Business - Creating a will - Giving away keepsakes 5. Depression - Individual experiences an increasing number of losses of function and somatic symptoms - Reduction of interests 6. Acceptance - Individual has been allowed to grieve - Individual comes to terms with the inevitable outcome - Usually a period of quiet expectation -can be a process of dying of the person or grief of their loved ones •Not all individuals move through these stages in a linear fashion •Some individuals may never reach the acceptance stage
Atrial Fibrillation (A-Fib)
Asynchronous contraction of the atrial muscle fibers so atrial pumping ceases altogether -Can result in an MI, but in a strong heart it reduces the pumping effectiveness by only 20-30%
Impairments and Adaptations for Self-Feeding
Impaired Grip •Built-up utensils •Easy-grip cups with one or two handles Absent Grip •Universal cuff •Utensil holder Limited Upper Extremity Movement or Control •Curved or angled utensils •Extension utensils Tremors •Weighted utensils •Wrist weight •Weighted cup with lid Limited wrist movement or grip strength •Rocker knife Low Vision •Dishes in contrasting color to the food Difficulty Scooping •High-sided dished •Compartment plates •Clip-on food guards Use of Only One Hand •Suction cups or non-skid mat
Make a decision
Meet with the team and with the client/surrogate List the alternative for care Negotiate a mutually acceptable decision
Tips for Designing Training Programs
Motivation and self-concept can affect training involvement and success: -Encourage older workers to attend -Provide positive feedback -Reminders of training goals -Environment can affect motivation as well: lighting, noise, temperature, rest periods. Structure: -Relevant to job based on job analysis -Master each component of task before moving on.
Coronary Heart Disease (CHD)
Myocardial damage due to insufficient blood supply
Coronary Artery Disease (CAD)
Narrowing of the coronary arteries sufficiently to prevent adequate blood supply to the myocardium -CAD: heart feeding blood to the body, body not giving blood to heart muscle
Full weight-bearing (FWB)
No restrictions on the amount of weight placed on the operated LE
Occupational Dysfunction
Occupational Imbalance -Lack of balance among work, rest, self-care and leisure -Failing to meet a person's needs, resulting in decreased health, well-being or both Occupational Deprivation -Circumstances or limitations preventing a person from acquiring, using or enjoying occupations Occupational Alienation -Sense of estrangement and lack of satisfaction in one's occupations
Wellness programs in the work place
Older workers and retirees express interest in the following areas: -Weight management -Physical fitness and exercise -Health after retirement -Nutrition
Designing Training Programs for the Older Adult Worker
Older workers receive less training than younger workers do. Barriers to training include: Situational: (may be unaware, lack money) -Need to educate management and workers that older workers are capable of learning -Incentive programs help (paid release time, tuition reimbursement) Dispositional: (self-perception too old to learn) -Managers can encourage participation Institutional: -Inconvenient times -Inaccessible sites
PAIN
PAIN IS WHATEVER THE PATIENT SAYS IT IS, WHENEVERTHEY SAY IT IS
Non-weight bearing (NWB)
Unable to put ANY weight on the operated LE
State the Dilemma
What are the ethical issues What ethical guidelines are being used
Negative Connotations of Low Vision and Legal Blindness
When a patient receives one of these diagnosis, he or she often has the false impression that they have no usable vision The patient may then not seek low vision services Part of the challenge of providing low vision rehabilitation is to -Reverse the negative self-perception of the label of legal blindness -Assist the individual in viewing themselves as capable of using vision for function
Total Knee Replacement (TKR)
When cartilage is significantly damaged and worn a prosthesis (artificial knee) can be implanted The most common cause for a TKR is severe pain -Knees can become unstable and lead to falls -Patient's independence is compromised and quality of life is decreased
Visual Attention: Copying Ability
Write telephone numbers on one side of the page at a font level the patient can read Place the test at midline in front of the patient Tell the patient to copy the numbers onto the line on the other side of the page Circle mistakes to see any patterns
Contrast sensitivity
ask functional questions -Can you see features on someone's face -Can you see when water is boiling -Can you see water in a glass or coffee in a dark-colored cup Amsler Grid for Macular Degeneration https://www.amslergrid.org/AmslerGrid.pdf
oculomotor control
saccades, convergence, and smooth pursuits
Contrast Discrimination
the capacity to distinguish between similar shades of light and dark -contrast discrimination = difference in color (difficult to distinguish faces/facial features) (not able to see white clothes placed on a bed with a white bed sheet)
Glare Modulation
the capacity to regulate light and control glare -glare off the floor is common -have to be able to modulate glare to function
Acuity
the level of detail and clarity with which an individual sees objects -can you see
Visual Field:
the range of the area one sees in a single view without turning the head or eyes -visual field = range of vision (narrow = difficulty with peripheral vision)
Interventions for Clients with Malnutrition: Poor oral health is a large risk factor in malnutrition
•Educate the client and/or caregiver about selecting and preparing softer foods •Educate the client and/or caregiver about compensatory and restorative skills regarding oral hygiene •Provide resources to the client and/or caregiver regarding dental care 1)Tooth decay and gum disease are prevalent in older adults 2)Oral health problems from missing teeth, ill-fitting dentures or infection can cause difficulty with eating 3)Many medications can cause dry mouth, leading to difficulty with chewing and swallowing 4)Access to dental care become more difficult 5)Loss of teeth can lead to low self-esteem, leading to decreased socialization and depression -overall hard to enjoy food and eating/chewing when mouth is affected
dealing with death
•Expression and emotions surrounding death are culturally bound •Practitioners must understand their own religious/cultural beliefs regarding death •Practitioners must understand the context the client is coming from •Clients need to know they have been productive, have made a difference -some cultures celebrate death -productive life has a unique definition to everyone
Interventions for Clients with Malnutrition: Limited ability or knowledge for healthy meal preparation
•Hold individual OT sessions for the older adult and/or caregiver that target healthy meal preparation and safe kitchen mobility •Educate the caregiver about healthy cooking, proper feeding techniques, and safe positioning of the older adult •Do home visits for healthy meal preparation within the client's natural environment •Consult with home health providers for support and guidance with eating •Create a support group for those who are widowed to teach techniques for healthy meal preparation 1)Can be interprofessional and include a nutritionist -scheduling meals, meal preparation, grocery shopping, transportation to places with quality food sources, etc. -look for caregiver neglect -positioning for proper intact without aspiration, having a task light so they can see the food, etc. -creating a pleasant environment (no bad smells, no obnoxious sounds, food looks presentable on the plate, etc.) -resources provided on meal services (meals on wheels, etc.)
The undernourished older adult
•In 2013, 23.1% of older adult women and 14.5% of older adult men were malnourished •Widows or widowers are at the greatest risk •Pathologic weight loss is often due to depressive symptoms and medication side effects 1)Widower's are often not socialized to care for their own nutritional needs, as their spouse was the primary person responsible for meal preparation -anorexia in the sense that they don't eat enough -common with widows/widowers because not cooking for other people, no one there to tell you to eat right, depression, social aspect of no one to eat with, etc.
Vitamin D Deficiency
•Increased risk of osteoporosis •Increased fall risk •Increased hip fracture risk •Functional deterioration •Increased risk of mortality
Vitamin B6 Deficiency
•Increased risk of vascular disease •Increased risk of cognitive decline •Anemia •Increased risk of depression •Increased risk of age-related macular degeneration
Common Nutritional Problems in Older Adults
•Loss of social interaction •Absorption of nutrients is naturally decreased •Spinal cord compression due to osteoporosis decreases abdominal space and food intake 2) Abdominal surgeries may impair nutrient absorption in the gut -sitting more slumped à decreased abdominal space
Role of Occupational Therapy in Hospice
•Maintain client independence as long aspossible •Transition from independence to interdependence to dependence as function declines •Provide assistance to caregivers
Hospice Reimbursement
•Medicare hospice benefit •Medicaid hospice benefit •Private insurance benefit •Self-pay Patients are eligible for services regardless of the ability to pay -never turned away if you are unable to pay (i.e., homeless population cared for in hospice facility)
Hospice history
•Modern hospice started in 1969 in London and provided: -Palliative care -- intervention that alleviates or controls symptoms, but does not cure the underlying disease -Honest diagnostics -Caregiver support -Addressed quality of life -Bereavement services •1971 marked start of hospice home care •First U.S program began in Connecticut in 1971 •Hospice now exists in all 50 states •Hospice can be: -Free standing institution -Exist within an institution -Home-based •Most hospice in the U.S. is home-based
Hospice in the US
•Most Americans are completely unaware of hospice services •Nearly 80% of Americans do not think of hospice as a choice for end-of-life care •Approximately 75% do not know that hospice care can be provided at home •90% of Americans do not know that Medicare pays for hospice •Many Americans are unwilling to talk about the end of life and end-of-life care •25% of Americans say they are not likely to talk about impending death with terminally ill parents •Fewer than 25% have put in writing how they want to be cared for at the end of life
Grocery Shopping Problems
•Necessary part of food preparation, but often overlooked •May be impacted by socioeconomic status or access to a grocery store •Low vision •Mobility issues •Decreased activity tolerance -paying for what they can afford -low vision = unable to read price tag or nutrition labels, can they get to the store, etc. -mobility = can they push the cart, carry the bags, etc. -ex: neuropathy and using cart to steady self
Calcium Deficiency
•Osteoporosis
Hospice Team
•Patient and primary caregiver •Physician -Attending physician -Hospice Medical Director •Nurse Case Manager •Social Worker •PT, OT, ST, Nutrition •Pastoral Care -Spiritual -Bereavement •Counseling •Home Health Aides •Volunteers
OT assessment in hospice
•Perform full occupational history •Identify routine differences between past and present •Performance Assessment •Psychosocial assessment with regard to: -Client's concept of death -Client's self concept -Client's self esteem •Caregiver needs -transition process (stage of life)
PLISSIT MODEL
•Permission Permission to talk about the issue Supportive confidential environment Assurance about feelings •Limited Information General information regarding specific diagnosis Accurate answers •Specific Suggestions •Intensive Therapy
